CLoWI Versus PCA Morphine for Pain Control After Major Abdominal Surgery (CLoWI)
Surgical Wound, Post-Op Complication, Opioid Use
About this trial
This is an interventional treatment trial for Surgical Wound focused on measuring continuous local wound infusion, opioids, post-operative pain, surgical incision
Eligibility Criteria
Inclusion Criteria:
- Planned for elective or urgent# open abdominal surgery
Abdominal Surgery may include the following procedures:
A) Urgent laparotomy for perforated viscus, intestinal obstruction. B) Elective abdominal surgery for upper and lower gastrointestinal surgery
- Ability to provide informed consent. A signed and dated written informed consent prior to study participation.
- Age 21 to 80 years for both males and females
Exclusion Criteria:
- Female subject who is pregnant
- Inability to comply with PCA instructions due to physical disabilities. For example, visual or hearing impairment, arthritis, peripheral neuropathy.
- Known allergy to local anaesthetic or opioid drugs (Morphine).
- Current or recent on opioid therapy. For example due to chronic pain illness, opioid (or other) drug abuse or recent surgery.
- Severe comorbid diseases including liver cirrhosis, renal failure requiring dialysis, Grade 4 NYHA (New Yoke Heart Association) heart failure, respiratory illness requiring NIV (Non-Invasive Ventilation), etc.
- Severe associated acute illness American Society of Anesthesiologists (ASA) Grade 4 or 5 where survival following surgery is not expected
Sites / Locations
- National University Hospital
- Ng Teng Fong General Hospital
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
CLoWI
PCA
CLoWI (ropivacaine) and PCA (normal saline) The local anaesthetic infusion will be administered via 2 catheters using a ON-Q® (Halyard) delivery system that will be placed under direct vision by the surgeon at the time of wound closure. 40 mls of 0.25% ropivacaine are infiltrated in the preperitoneal plane. 0.5% ropivacaine will be infused at a rate of 4mls/hour (2mls/hour in each catheter). The dosage 40 mls of 0.25% ropivacaine and 0.5% ropivacaine at 4mls/hr (20mg/hr) over 4 days will be less than the recommended toxic dose of 3-4 mg/kg.
PCA (Morphine) and CLoWI (normal saline) Morphine will be administered via the standard PCA protocol in accordance to the hospital's Acute Pain Service Programme: Concentration: 1mg/ml Bolus (Loading): 1mg Lockout Interval: 5 minutes Maximum hourly dose of 10mg