The Interest of the Xylocaine® and Ketamine on the Management of Acute and Chronic Ain After Colectomy by Laparoscopy

University Hospital, Lille135 enrolled

Overview

Recent clinical studies in abdominal surgery have shown that the use of Xylocaine® parenterally intraoperative at plasma concentrations below the toxic threshold of 5 .mu.g / ml, had an analgesic effect and decreased postoperative morphine consumption. This study aims to evaluate the activity of Xylocaine® and ketamine separately administered parenterally, in terms of postoperative morphine consumption and decrease incidences of postoperative chronic pain at 3 and 6 months after laparoscopic colectomy compared the placebo group. The evaluation of the intensity of postoperative pain, hyperalgesia perished skin surface scarring) and pain perception threshold by Pain Matcher® confirm or not the predictive nature of these criteria in the occurrence of chronic pain.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

TRIPLE

Enrollment

135

Conditions

Pain, Postoperative

Interventions

Xylocaine is administered at a dose of 1.5 mg / kg for induction and then relay by syringe pump at a dose of 1.33 mg / kg / hour will be administered throughout the duration of the intervention and for 24 hours after the end of thereof, to obtain deemed effective plasma concentrations of the order of 0.5 to 5 mcg / mL.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Surgery: segmental or total colectomy performed by laparoscopy * Anesthesia state 1 and 3 Exclusion Criteria: * Patients classified Anesthesia state 4 or 5 * Allergy or intolerance to any of the products used in the protocol * Creatinine clearance calculated by the Cockcroft formula below 50 ml / min * Hepatocellular insufficiency * Severe heart failure * Peptic ulcer * Chronic inflammatory bowel disease (IBD) * Previous history of epilepsy or seizures * Surgery emergency, palliative surgery, revision surgery * Chronic pain requiring regular intake of analgesics include opioids * Patients treated with lidocaine patch * Psychic Disorder * Additive Conduct vis-à-vis alcohol or mind-altering substances * Pregnant or breastfeeding women

Outcomes

Primary Outcomes

Morphine consumption

Time frame: During the first 24 postoperative hours.

Secondary Outcomes

Morphine consumption

Time frame: All 6 hours during the 48 postoperative hours.

Numeric rating scale score

Time frame: All 2 hours during the first 24 postoperative hours and all 6 hours during the 48 postoperative hours.

Electric nociception threshold measured by PainMatcher

Time frame: All 2 hours during the first 24 postoperative hours and all 6 hours during the 48 postoperative hours.

Hyperalgesia of peri-scar (in cm²) with a von Frey filament (pressure of 10 grams

Time frame: At 2 days after postoperative

Questionnaire Douleur de Saint-Antoine (QDSA) ,

evaluation with validated scores for chronic and neuropathic pains

Time frame: at 3 months, at 6 months

Questionnaire d'Evaluation des Douleurs Neuropathiques (QEDN),

evaluation with validated scores for chronic and neuropathic pains

Time frame: at 3 months, at 6 months

Time physiological function recovery

Ability to drink, to eat, to urinate, to walk

Time frame: During the first 24 postoperative hours

Duration of hospital stay

Time frame: At 5 days after postoperative