Opioids have been used for analgesia since many years, but despite potent analgesia they are also associated to side effects, including opioid induced Hyperalgesia (OIH). OIH in the surgical setting is debated, and may predispose patients to higher analgesic consumption in the preoperative period, and peripheral and central sensitization. The aim of the study is to compare remifentanil-based vs non opioid analgesia (clonidine, lidocaine, ketamine) for intraoperative management of patients undergoing laparoscopic left hemicolectomy, with the hypothesis that non- opiod treated patients will have lower morphine consumption in the first 24 hours after surgery. Peripheral and central hyperalgesia will be tested with Von Frey hairs and pin-prick to evaluate acute CNS (Central Nervous System) sensitization after surgery. Acute and persistent (1 and 3 months) pain will be registered, together with any side effect and parameters of surgical rehabilitation.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
64
continuous infusion intraop
bolus 0,5 mg/kg + infusion 0,25 mg/kg/h
lidocaine bolus 1 mg/kg + infusion 1 mg/kg/h
clonidine 4 mcg/kg
University Hospital
Parma, Parma, Italy
RECRUITINGanalgesic consumption
morphine mg by PCA (Patient Controlled Analgesia)
Time frame: 24 HOURS
side effects
nausea and vomiting, ileus, itching, shiver, hypotension, bradycardia, sedation
Time frame: 4 days after surgery
Pain Score on the Visual Analog Scale
VAS (Visual Analog Scale)
Time frame: 3 months
peripheral sensitization
assessment of primary hyperalgesia by Von Frey Filaments at 24 hours
Time frame: 24 hours
central sensitization
assessment of secondary hyperalgesia by pin-prick test at 24 hours
Time frame: 24 hours
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