Insertion Distance of Thoracic Epidural Catheters in the Context of Thoracotomy Procedures.

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
Centre hospitalier de l'Université de Montréal (CHUM)
ClinicalTrials.gov Identifier:
NCT00754195
First received: September 15, 2008
Last updated: April 18, 2013
Last verified: April 2013

September 15, 2008
April 18, 2013
September 2008
June 2010   (final data collection date for primary outcome measure)
Quality of sensory block [ Time Frame: At one hour, 24 hours and 72-96 hours after surgery ] [ Designated as safety issue: No ]
Quality of sensory block [ Time Frame: 72-96 hours after surgery ] [ Designated as safety issue: No ]
Complete list of historical versions of study NCT00754195 on ClinicalTrials.gov Archive Site
Quality of pain relief [ Time Frame: At one hour, 24 hours and 72-96 hours after surgery ] [ Designated as safety issue: No ]
Quality of pain relief [ Time Frame: 72-96 hours after surgery ] [ Designated as safety issue: No ]
Not Provided
Not Provided
 
Insertion Distance of Thoracic Epidural Catheters in the Context of Thoracotomy Procedures.
Influence of the Insertion Distance on Loss of Sensation Produced by Thoracic Epidural Catheters in the Context of Thoracotomy Procedures.

This study is designed to compare thoracic epidural catheter insertion distances, in order to determine which is the best for pain relief following a thoracotomy.

HYPOTHESIS :

  1. The quality of the sensory blockade one hour following the end of surgery will not be inferior if the catheter is inserted deeper (7 cm compared to 3 and 5 cm)
  2. The quality of the sensory blockade at 24 and 72-96 h will not be inferior if the catheter is inserted at 3 cm.

Thoracic surgery such as posterolateral thoracotomy is associated with severe postoperative pain. Pain control is particularly important, as adequate analgesia allows rapid mobilisation and prevents complications related to immobility. Over the last years, thoracic epidural analgesia has become increasingly popular and is now considered the gold standard after thoracotomy. Thoracic epidural analgesia improves pain relief and also significantly decreases the incidence of morbidity and mortality following pulmonary resection. It also reduces the length of stay in the hospital and long-term pain 6 months after surgery. This method is now offered to a majority of patients undergoing a thoracotomy in our hospital.

The placement of a catheter in the thoracic epidural space remains a challenge for the anesthesiologist. Suboptimal placement of the catheter within the epidural space can result in inadequate pain relief. The distance at which the catheter must be advanced in the thoracic epidural space remains unknown. Insertion distance could influence the initial quality and distribution of sensory blockade, its duration, or both. Therefore, this study is designed to compare three catheter insertion distances, in order to help determine which is best for pain relief after a thoracotomy.

Methods :

  1. Insertion of the epidural catheter :

    Patients will be randomly assigned to the following groups :

    • Group 1 : 3 cm insertion
    • Group 2 : 5 cm insertion
    • Group 3 : 7 cm insertion

    The anesthesiologist will insert the epidural catheter at T6-T7 before the induction of anesthesia for surgery. The usual medication will be used to make catheter installation comfortable. Standard non-invasive monitoring will be used.

    Correct placement of the epidural catheter will be assessed by infusing a bolus of 5 mL of lidocaine 1.5% with epinephrine 1 : 200,000. If no decrease to cold sensation is displayed over at least two thoracic dermatomes, a higher concentration, 5 mL testing bolus of lidocaine (2%) will be given after ten minutes. If a decrease to cold sensation is still not detected after ten minutes, the epidural catheter will be reinserted and managed using the same protocol. After induction of anesthesia and after placing the patient in the lateral decubitus position, the epidural infusion (bupivacaine 0.1% and fentanyl 2 mcg/mL) will be started at a rate of 0.1 mL/kg/h. Adjustments will be made between 4 to 16 mL/h with boluses of 0.1 mL/kg (maximum 7 mL) of solution as needed.

    Surgery will be performed under general anesthesia using a standardised protocol.

  2. Post-operative analgesia :

    Pain will be assessed using a verbal numeric rating scale (NRS), where 0 refers to " no pain " and 10 refers to " the worst pain imaginable ". Pain at the surgical site and post-thoracotomy shoulder pain will be assessed separately.

    Post-thoracotomy shoulder pain will be treated with acetaminophen 975 mg every 6 hours and NSAIDs or opioids as needed.

    Patients experiencing moderate to severe pain at the surgical incision site will receive a bolus of 0.1 mL/kg (maximum 7 mL) of epidural solution, and the infusion rate will be increased in 2 mL/h increments, to a maximum infusion rate of 16 mL/h.

    At arrival in the recovery room, sensory block wil be assessed. The infusion rate will be adjusted to maintain a pain score at the surgical site of 3 or less on the numeric rating scale.

    One hour after arrival in the recovery room, sensory block will be reassessed by a member of the research team who is blinded to the patient's group assignment.

  3. Follow-up

At 24 hour and three to four days after surgery for patients who are still in the hospital, the total volume of epidural solution administered since surgery will be recorded.

The cumulative dosage of opioids administered to treat shoulder and surgical incision pain since surgery will be recorded.

Catheter distance will be measured at the skin before removal.

Interventional
Not Provided
Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Outcomes Assessor)
Primary Purpose: Treatment
Pain
Other: Thoracic epidural catheter
Comparison of 3 insertion distances (3,5 and 7 cm) for a thoracic epidural catheter in the context of thoracic surgery.
  • Active Comparator: 1
    Insertion distance of thoracic epidural catheter: 3 cm
    Intervention: Other: Thoracic epidural catheter
  • Active Comparator: 2
    Insertion distance of thoracic epidural catheter: 5 cm
    Intervention: Other: Thoracic epidural catheter
  • Active Comparator: 3
    Insertion distance of thoracic epidural catheter: 7 cm
    Intervention: Other: Thoracic epidural catheter
Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Completed
120
June 2010
June 2010   (final data collection date for primary outcome measure)

Inclusion Criteria:

  • Patients aged 18 years and older undergoing an elective thoracotomy.

Exclusion Criteria:

  • Infection or sepsis
  • Coagulopathy
  • Hypovolemia
  • Allergy to local anesthetics
  • Neuropathy that could affect study assessments
  • Pregnancy
Both
18 Years and older
No
Contact information is only displayed when the study is recruiting subjects
Canada
 
NCT00754195
08.071
No
Centre hospitalier de l'Université de Montréal (CHUM)
Centre hospitalier de l'Université de Montréal (CHUM)
Not Provided
Principal Investigator: Stephan R Williams, MD, PhD Centre Hospitalier de l'Université de Montréal
Centre hospitalier de l'Université de Montréal (CHUM)
April 2013

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP