The use of epidural catheters for postoperative analgesia in pancreatic surgery is recommended by the guidelines of the ERAS society. Some studies claim it may expose to hemodynamic alterations that may compromise outcome and increase postoperative complications, attributable to a malfunction of the catheter itself, often linked to a bad positioning, since this is usually positioned with LOS technique. Our hypothesis is that a positioning made using the radiographic guide the day before the intervention can significantly reduce the number of catheter's dysfunctions.
About 30% of epidural catheters are reported to have hypo or hyper functioning behaviour. This has and impact on postoperative pain control and can affect also surgical and global outcome since it is known that a malfunctional catheter carries an increased complication's rate. Our hypothesis is that rx-guided positioning can reduce the incidence of catheter malfunction afrom 30 to 15 %.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
SINGLE
Enrollment
154
placement of epidural catheters with LOS technique
placement of epidural catheters with x-ray guide
Azienda ospedaliero-universitaria integrata Verona
Verona, Veneto, Italy
RECRUITINGIncidence of catheters malfunctions in LOS and X-ray group
malfunctional catheters are defined as following: * symptomatic hypotension due to epidural infusion * NRS \> 6 in the first postoperative day and NRS \> 4 in subsequent postoperative day * overt malpositioning: * rx evidence of catheter's tip under T10 during routine rx or TC * NRS \> 6 (due to pain at T7-10 dermatomers) with 5 cc/h catheter infusion and response to lidocaine 1% 6ml bolus (low tip) * NRS \> 6 (due to pain at T7-10 dermatomers) with 5 cc/h catheter infusion and NO response to lidocaine 1% 6ml bolus ( not in epidural space or very low tip) * evidence of catheter accidental removal Numerical Rating Scale (NRS) is used to assess pain. Patients self-report actual pain on 0 to 10 scale where 0 is no pain and 10 is the worst immaginable pain.
Time frame: every day until 7th postoperative day
Evaluate daily pain differences between groups: NRS (Numeric rating scale)
Parameter used -higher postoperative daily numeric rating scale (NRS) until catheter removal Numerical Rating Scale (NRS) is used to assess pain. Patients self-report actual pain on 0 to 10 scale where 0 is no pain and 10 is the worst immaginable pain.
Time frame: every day until 7th postoperative day
Monitoring postoperative surgical complications between groups
Complications are considered as: * bleedings * infections * pancreatic fistulas (degree) * biliary fistulas * abdominal collections * ICU admission * needs of new surgery (for any reasons) * pneumonia * delayed gastric emptying
Time frame: at 30th postoperative day
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