The purpose of this study is to find out whether the use of Painbuster® (a local anaesthetic wound catheter) can be used instead of epidurals for patients having bowel surgery in an enhanced recovery programme. The investigators want to find out whether or not using this device means people need to stay in hospital for less time after surgery.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
60
Epidural analgesia inserted prior to surgery to stay in until at least the second postoperative day
The catheter will be used to infuse the wound with local anaesthetic for 48 hours post op.
Scarborough General Hospital
Scarborough, North Yorkshire, United Kingdom
RECRUITINGLength of hospital stay
Length of stay will be measured in days for each group.This will be determined by a set of predefined discharge criteria.
Time frame: determined on discharge from hospital
Postoperative complications
All complications in the postoperative period will be recorded. Particular emphasis will be given to: * Wound infection: this will be defined as clinical evidence of purulent discharge and erythema accompanied by microbiological (culture of microorganisms) and haematological evidence (raised white cell count) * Cardiac failure: This will be defined as the presence of clinical signs of fluid overload accompanied by radiological features on a chest X-Ray. * Complications related to epidural/spinal * Adequacy of deep vein thrombosis prophylaxis
Time frame: Whilst an inpatient
Episodes of hypotension in the postoperative period
This will be defined as a systolic blood pressure of less than 90 mmHg
Time frame: whilst an inpatient
Postoperative pain
This will be assessed objectively using the visual analogue scale for pain. Measurements will be taken twice a day for as long as the epidural catheter or Painbuster® is in situ. Pain scores will be measured at rest and on coughing.
Time frame: as an inpatient
Amount of postoperative IV fluid administered
This will be documented on each postoperative day.
Time frame: as an inpatient
Body composition
Body composition (Fat Mass, Fat Free Mass, Extracellular Fluid Volume, Intracellular Fluid Volume, and Total Body Water) will be determined using a bioelectrical impedence analysis (BIA) machine, specifically the "Bodystat" machine.
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Time frame: Tests will be performed daily until the epidural or Painbuster® has been removed.
Postoperative analgesic requirement
The total quantity and type (opiate or non-opiate) of all analgesics administered during the period when epidurals or Painbuster® was in situ will be recorded.
Time frame: As an inpatient
Postoperative stress response
This will be assessed using: SIRS criteria C reactive protein Indirect calorimetry on alternate days at a fixed time.
Time frame: As an inpatient
Anaesthetic time required
he time taken in minutes for insertion of epidural or wound catheter will be recorded in each group.
Time frame: On the day of operation
Postoperative mobility
Postoperative mobility will be assessed as time until sit to stand aided and unaided, duration of time spent out of bed on each postoperative day and maximum walking distance with assistance on a daily basis. In addition, assessment of mobilisation will be carried out by the physiotherapists who will record this in patient notes. All patients will be given pedometer to wear which will count the number of steps taken. Pedometer readings will be taken twice a day. Pedometers have been previously validated as an objective measurement of mobility.
Time frame: as an inpatient
Day of return of gut function
Return of gut function will be defined by the tolerance of \>/= 80% of the prescribed nutritional requirement. This will be assessed by a dietician.
Time frame: As an inpatient