Opioid neuraxial analgesia for major open abdominal surgery: A feasibility study using a combination of intrathecal and epidural morphine
Grant Title
Opioid neuraxial analgesia for major open abdominal surgery: A feasibility study using a combination of intrathecal and epidural morphine
Chief Investigator/s
Administering Institution/s
Alfred Health and Peter MacCallum Cancer Centre
ANZCA Area of Research
Anaesthesia
Project Summary
Major abdominal surgery is common, encompassing a broad range of surgical subspecialities and patient populations. It is associated with significant morbidity, some of which can be reduced with effective analgesia. Suboptimal postoperative pain management also negatively affects quality of life and functional recovery and is a risk factor for persistent post-surgical pain and long-term opioid use. The adverse effects of epidurals, and inconsistent clinical benefits, has resulted in a decline in popularity for epidural regional anaesthesia and an increased interest in ITM. However, a limitation of ITM is that after 24 hours, the analgesic effect diminishes.
We propose to place an epidural catheter at the time of the ITM injection for extended postoperative pain management using opioids only. As with intrathecal opiates, epidural opiates act directly on opiate receptors on spinal nerves eliciting prolonged action with higher potency at lower doses, to minimise the side effects related to parenteral opiates and to avoid epidural local anaesthetic infusions and their associated risk of hypotension and need for pressor support. We hypothesise that epidural morphine use will enhance functional and quality of recovery, be an opioid sparing, safe and effective alternative to intravenous or oral opioid following major abdominal surgery. Should feasibility outcomes be achieved, we will proceed with a large definitive trial to investigate our hypothesis.
We propose to place an epidural catheter at the time of the ITM injection for extended postoperative pain management using opioids only. As with intrathecal opiates, epidural opiates act directly on opiate receptors on spinal nerves eliciting prolonged action with higher potency at lower doses, to minimise the side effects related to parenteral opiates and to avoid epidural local anaesthetic infusions and their associated risk of hypotension and need for pressor support. We hypothesise that epidural morphine use will enhance functional and quality of recovery, be an opioid sparing, safe and effective alternative to intravenous or oral opioid following major abdominal surgery. Should feasibility outcomes be achieved, we will proceed with a large definitive trial to investigate our hypothesis.
Grant Type
CTN Pilot
CTN Endorsed Study
No
Funding Year
2022
Funding Amount
$A15,000
Status
In Progress
Publications
(All)
Date issued
Type
Fulltext
Results 1-1 of 1 (Search time: 0.002 seconds).
| Preview | Issue Date | Title | Author(s) | |
|---|---|---|---|---|
| 1 | Sep-2022 | Current approaches to acute postoperative pain management after major abdominal surgery | Pirie, K ; Traer, E ; Finniss, D ; Myles, PS ; Riedel, BJ |