Analgesia in liver surgery is a challenge, postoperative coagulopathy risk raises fears an epidural haematoma formation following the epidural analgesia, "gold standard" in major abdominal surgery. The spinal analgesia and/or continuous wound infiltration of local anesthetics constitute so an alternative. The study will compare the continuous infiltration of local anesthetics and rachianalgesia in terms of decreased postoperative morphine consumption and incidences of chronic postoperative pain at 3 and 6 months after hepatic surgery compared to the control group.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
186
A single intrathecal injection of 300 micrograms of Morphine preoperatively, just before induction.
a postoperative Morphine PCA
Ropivacaine 2mg / ml at the rate of 8ml per hour via a multiperforated catheter with connector after bolus of 20 ml
CHRU , Hôpital Claude Huriez
Lille, France
Morphine Consumption
Morphine consumption is measured all 3 hours during the first 24 hours post operative
Time frame: During the first 24 hours post operative
Morphine Consumption
Morphine consumption is measured all 3 hours during the 48 hours post operative
Time frame: During the 48 hours post operative
Evaluation of postoperative pain intensity at rest
The postoperative pain intensity is measured by Visual Analog Scale at rest
Time frame: All 3 hours during the 48 postoperative hours
Evaluation of postoperative pain intensity after activity
The postoperative pain intensity is measured by Visual Analog Scale after activity
Time frame: All 3 hours during the 48 postoperative hours
Electric nociception threshold measured by PainMatcher
The Electric nociception threshold is measured by PainMatcher (CefarCompex®)
Time frame: At the exit of Post Anesthesia Care Unit
Electric nociception threshold measured by PainMatcher
The Electric nociception threshold is measured by PainMatcher (CefarCompex®)
Time frame: At 24 hours post operative
Electric nociception threshold measured by PainMatcher
The Electric nociception threshold is measured by PainMatcher (CefarCompex®)
Time frame: At 48 hours post operative
Number of patient with a chronic pain after liver surgery, measured by Questionnaire Douleur de Saint-Antoine (QDSA)
Evaluation with validated score for chronic and neuropathic pains (QDSA is the French translation of the MPQ "Mac Gill bread questionary")
Time frame: At 3 months after surgery
Number of patient with a chronic pain after liver surgery, measured by Questionnaire Douleur de Saint-Antoine (QDSA)
Evaluation with validated score for chronic and neuropathic pains (QDSA is the French translation of the MPQ "Mac Gill bread questionary")
Time frame: At 6 months after surgery
Number of patient with a chronic pain after liver surgery, measured by Neuropathic Pain Symptom Inventory (NPSI)
Evaluation with validated score for chronic and neuropathic pains (NPSI)
Time frame: At 3 months after surgery
Number of patient with a chronic pain after liver surgery, measured by Neuropathic Pain Symptom Inventory (NPSI),
Evaluation with validated score for chronic and neuropathic pains (NPSI)
Time frame: At 6 months after surgery
Number of patient with a chronic pain after liver surgery, measured by Neuropathic pain diagnostic questionnaire (DN2),
Evaluation with validated score for chronic and neuropathic pains (DN2)
Time frame: At 3 months after surgery
Number of patient with a chronic pain after liver surgery, measured by Neuropathic pain diagnostic questionnaire (DN2),
Evaluation with validated score for chronic and neuropathic pains (DN2)
Time frame: At 6 months after surgery
Area peri-incisional hyperalgesia
The Surface of the cutaneous Area peri-incisional hyperalgesia is measured by Von frey's Filament.
Time frame: At 48 hours post operative
Number of nausea and/or vomiting episodes
Measured by collection of episodes of nausea and/or vomiting and consumption of anti-emetics
Time frame: At 24 hours after surgery
Number of nausea and/or vomiting episodes
Measured by collection of episodes of nausea and/or vomiting and consumption of anti-emetics
Time frame: At 48 hours after surgery
Number of nausea and/or vomiting episodes
Measured by collection of episodes of nausea and/or vomiting and consumption of anti-emetics
Time frame: At 72 hours after surgery
Number of patient with side effect of morphine consumption
Respiratory Depression, Urinary retention, Prurit
Time frame: Up to 72 hours after surgery
Time physiological function recovery
Nasogastric tube withdrawal time, Transit recovery, Ability to drink, to eat, to urinate, to walk
Time frame: Up to the end of hospital stay, an average 10 days
Length of hospital stay in intensive care unit
Time frame: Up to the end of hospital stay,an average 10 days
Length of hospital stay
Time frame: Up to the end of hospital stay , an average 10 days
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