Clinical Trial: Effect of Continuous Thoracic Epidural Analgesia on Gut Motility Following Emergency Laparotomy

Study Status: Completed
Recruit Status: Completed
Study Type: Observational

Official Title: Effect of Continuous Thoracic Epidural Analgesia on Gut Motility Following Emergency Laparotomy for Intestinal Perforation Under General Anesthesia

Brief Summary: Continuous thoracic epidural analgesia plays a very vital role in patients undergoing exploratory laparotomy. It not only supports a stable perioperative hemodynamics but also helps in early return of bowel activity.

Detailed Summary:

Intestinal perforation is one of the commonest surgical emergency that the investigators encounter in emergency. Perioperative management of most of such patients is a challenging task for the anesthesiologist, as patients are often hemodynamically unstable at the time of their presentation to emergency. Usual plan of anesthesia for these patients is general anesthesia with or without an epidural block. In routine practice the investigators often place an epidural catheter, primarily for postoperative analgesia, unless there is some contraindication to epidural analgesia. Most often lower thoracic epidural is preferred because of longer length of the laparotomy incision. Thoracic epidural analgesia with local anesthetic (LA) is not only effective in managing the post-operative pain; it is also helpful in supplementing intra-operative analgesia with reduced requirement of anesthetic, muscle relaxant and the analgesic (opioid) drugs. In addition, it has also been reported to be associated with early return of gut motility.

It appears that absent / significantly reduced pain leads to lesser stress response, leading to less sympathetic activation and lesser catecholamine release. As catecholamines are inhibitory to gastrointestinal motility, earlier return of gastro intestinal (GI) motility can be achieved by reducing perioperative pain by continuous epidural analgesia. Moreover, an effective epidural analgesia with LA results in avoidance of opioid analgesics for optimal perioperative pain relief, which too may be helpful in achieving earlier return of gut motility.

Thus the investigators aimed at determining the effect of continuous thoracic epidural analgesia on return of gut motility in patients undergoing emergency exploratory laparotomy following intestinal perforation and compare it with those in whom epidural analgesia
Sponsor: Banaras Hindu University

Current Primary Outcome: Return of bowel sound [ Time Frame: Until 10th day after completion of surgery ]

Earlier return of bowel sounds in epidural group


Original Primary Outcome: Same as current

Current Secondary Outcome:

  • Passage of flatus [ Time Frame: Until 10th day after completion of surgery ]
    Earlier passage of flatus in epidural group
  • Feed tolerance [ Time Frame: Until 10th day after completion of surgery ]
    Earlier feed tolerance in epidural group
  • Hospital discharge [ Time Frame: Until 10th day after completion of surgery ]
    Earlier discharge from hospital in epidural group
  • Post operative pain [ Time Frame: Until 10th day after completion of surgery ]
    Lesser pain in epidural group


Original Secondary Outcome: Same as current

Information By: Banaras Hindu University

Dates:
Date Received: April 25, 2017
Date Started: March 20, 2016
Date Completion:
Last Updated: May 5, 2017
Last Verified: May 2017