The rationale for this study is to investigate the benefits of epidural analgesia in pancreatic resections in a prospective, single blind, randomized control trial. This study will evaluate both short and long-term outcomes related to epidural analgesia, providing a longitudinal and comprehensive perspective to the advantages and disadvantages of this technique. The investigators hypothesize that the use of epidural analgesia reduces a patient's consumption of morphine or morphine-equivalent in the post-operative period following pancreatic resections.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
SINGLE
Enrollment
23
Washington University School of Medicine
St Louis, Missouri, United States
Total consumption of morphine or morphine-equivalent in patients undergoing pancreatic resections in the control group compared with the study group
-Will be assessed every 24 hours
Time frame: First 72 hours after surgery
Effect of epidural analgesia during the initial post-operative period as measured by total intraoperative fluid volume
Time frame: During surgery
Benefit of epidural analgesia as measured by the reduction of persistent post-surgical pain (PPSP) after the operation
-Quantitative sensory testing will be performed on the abdomen in close proximity to the surgical incision
Time frame: Up to 6 weeks post-surgery
Benefit of epidural analgesia as measured by time to tumor recurrence
Time frame: Up to 2 years post surgery
Benefit of epidural analgesia as measured by disease-free survival
Time frame: Up to 2 years post surgery
Benefit of epidural analgesia as measured by overall survival
Time frame: Up to 2 years post surgery
Rate of delirium in the control group compared with the study group
* Assessed for delirium using the 3D-CAM instrument * Postoperative delirium assessments will be performed when patients can be around sufficiently in order to be assessed for delirium using the Richmond-Agitation-Sedation Scale. * Will be assessed for delirium once daily in the afternoon/evening
Time frame: First 72 hours after surgery
Effect of epidural analgesia during the initial post-operative period as measured by total post-operative fluid volume
Time frame: Up to 72 hours post surgery
Effect of epidural analgesia during the initial post-operative period as measured by volume of fluid boluses
Time frame: Up to 72 hours post surgery
Effect of epidural analgesia during the initial post-operative period as measured by amount of antiemetic doses
Time frame: Up to 72 hours post surgery
Effect of epidural analgesia during the initial post-operative period as measured by return of bowel function by time to first flatus
Time frame: Up to 72 hours post surgery
Effect of epidural analgesia during the initial post-operative period as measured by first bowel movement
Time frame: Up to 72 hours post surgery
Effect of epidural analgesia during the initial post-operative period as measured by length of hospital stay
Time frame: Up to 2 weeks post surgery
Effect of epidural analgesia during the initial post-operative period as measured by incidence of deep venous thromboembolism/pulmonary embolism
Time frame: Up to 72 hours post surgery
Effect of epidural analgesia during the initial post-operative period as measured by relative ratios of blood level inflammatory markers
-Specifically interleukin-1-beta (IL-1B), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-a), and interleukin 10 (IL-10) biomarkers
Time frame: Up to 6 weeks post-surgery
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