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Impact of Intravenous Lignocaine on Hospital Stay After Open Radical Prostatectomy: A Multicenter Trial

This multicenter trial investigates the effect of intravenous lignocaine followed by 24-hour subcutaneous infusion on hospital stay duration post-open radical prostatectomy. The study, conducted on eligible adult patients, evaluates pain management, opioid consumption, and recovery metrics. Results indicate a significant reduction in hospital stay by 1.3 days and enhanced recovery outcomes including faster mobilization and decreased pain scores compared to placebo. Safety and efficacy factors are discussed, offering insights for future applications in postoperative care.

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Impact of Intravenous Lignocaine on Hospital Stay After Open Radical Prostatectomy: A Multicenter Trial

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  1. Length of stay after open radical prostatectomy with intravenous lignocaine followed by 24-hour subcutaneous infusion: blinded, randomized, placebo controlled multicentre trial Laurence WeinbergStaff Anaesthetist, Austin Hospital, Victoria Clinical Fellow, Department of Surgery, The University of Melbourne.

  2. Acknowledgements • ANZCA: Project Grant • University of Melbourne • Story D, Gordon I, Christophi C • Co-investigators • Rachbuch C, Beilby D, Trinca J, Howard W, Yeomans M, Yanezas M, • James K, McNicol L

  3. Intravenous Lignocaine • Clear advantages: abdominal surgery • Lower pain scores • Opioid sparing effects • Enhances functional recovery • Reduces immune alterations • Decreases length of hospital stay

  4. Subcutaneous Lignocaine • Neuropathic pain • Ischaemic pain Limited data for ACUTE postoperative pain

  5. Hypothesis Intraoperative IV lignocaine + 24 hrs post-operative SC lignocaine Enhances recovery Shortens length of hospital stay after open radical retropubic prostatectomy

  6. Study Design • Prospective randomised multicentre • Blinded • Inclusion criterion • Adults (age > 18 years < 75 years) • Elective open radical prostatectomy • ASA I-III patients • Exclusion criterion • Creatinine > 200 umoll/L, Abn LFT’s • Chronic opioid use • Allergy: morphine, LA • Cardiac conduction defects/Class I anti-arrhythmic agents

  7. Study Design • Human Research Ethics approval • Consenting patients randomised 2 groups • GA: standardized, no regional anaesthesia • All patients: • Induction: Propofol: 1-3 mg/kg; Fentanyl 3 ug/kg • Maintenance: Volatile anaesthesia: 0.6-1 MAC, Fentanyl infusion 2.5 ug/kg/hr • Surgical closure: Paracetamol IV 1 g, Ketorolac 30 mg • Postoperatively: Morphine PCA, 1 mg boluses, 5 min lockout QID paracetamol, NSAID, Acute Pain Service

  8. Study Design • Lignocaine group: Pre-induction • Loading dose IV: 1.5 mg/kg • Intraop infusion IV: 1.5 mg/kg/hr

  9. Study Design • Lignocaine group: • Post-op SUBCUT infusion: 1.5 mg/kg/hr

  10. Study Design • Control group: • Normal saline: equal volume delivered in the same way

  11. Study Design • Primary outcome • Length of hospital stay • Secondary outcomes • GI function • Time to mobilise • Rescue analgesia and anti-emetic therapy • Visual Analogue Scores for pain (VAS) 0 to 100mm • Morphine consumption: 24 hours • Patient satisfaction • Opioid & lignocaine side effects • Lignocaine plasma levels: PACU & 24 hours • Adverse events

  12. Statistics analyses • Power analyses: based on a PILOT STUDY* for patients undergoing open radical prostatectomy (2007/8) who received PCA morphine alone: mean hospital stay 4.5 days (SD 26.4 hrs) • Sample size: 18 hour difference in hospital stay, power 0.8, significance level of 0.05, 38 patients per group • Analyses:intention-to-treat bases * Weinberg L, et al. Anaesthesia & Intensive Care2010; 38: A1116

  13. Consort diagram Total patients consented N = 85 Inclusion critreria met N = 75 Randomised Patients excluded N = 10 Laparoscopic retropubic prostatectomy N = 9 Procedure aborted (anaphylaxis) N = 1 Lignocaine Group N = 37 Placebo Group N = 38 Intention to treat Intention to treat

  14. Demographics * Data presented as SD, range

  15. Hospital Stay

  16. Operative variables • For comparison of means, standard two-sample t-tests were used • Uses Fisher's Exact Test due to comparison of proportions with small sample size

  17. Postoperative variables • Two-sample t-test was used for the comparisons of means • For the comparison of percentages, Fisher’s exact test was used for the p-values and the Newcombe-Wilson • approximation for the confidence intervals

  18. Adverse Effects (% patients)

  19. Post-op Complications

  20. Pain Rest Difference: 18 mm 95% CI: 7.3 – 28 mm P = 0.001

  21. Cumulative Morphine Difference: 13.9 mg 95% CI: 2.2 - 25.7 P = 0.02

  22. Cumulative Morphine Difference: -0.62 95% CI: -0.14 to -0.02 P = 0.02

  23. Adverse events • SC cannulae: nil complications • Inadvertent administration of lignocaine

  24. Lignocaine Levels • * Uses Mann-Whitney of medians (adjusted for ties) due to non-Normal data • Not appropriate for formal analyses of the 24-hour data as all values in placebo were recorded as < 0.5.

  25. Conclusions IV lignocaine followed by 24-hr SC infusion • Shorter length of stay (1.3 days) • Accelerated acute rehabilitation • Free fluid (3.9 hrs) • Diet (5.4 hrs) • Mobilisation (4.6 hrs) • Less 24-hour morphine use • Lower pain scores • Safety factors: paramount

  26. Future directions • Plasma levels & pain scores • Cancer recurrence • Chronic pain • Utility in laparoscopic radical prostatectomy

  27. Thank you 谢谢

  28. Future directions Pearson’s correlation is r = 0.09 here, a weak positive correlation (P = 0.6)

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