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Project properties

Title	Pre-peritoneal wound catheters as an alternative for epidural analgesia in gynecological oncology surgery.
Keywords	pre-peritoneal wound catheters gynecological oncology surgery Alternative for epidural analgesia
Researchers	dr. T. Roelofsen
Type of project	Pilot project (year 2 or 3) of Stage Wetenschap / Researchproject
Nature of the research	Determination of pre-peritoneal wound catheters as an alternative for epidural analgesia in gynecological oncology surgery.
Fields of study	anesthesiology gynaecology oncology

Background / introduction

adequate post-operative analgesia for patients is imperative for a good recovery after mayor surgery by laparotomy. Inadequate analgesia has been shown to be associated with severe morbidity, chronic pain symptoms, a lower quality of life and even increased mortality. Epidural analgesia is known for decades for its superior analgesic effect and is often considered as the golden standard regarding the method for peri- and post-operative analgesia in patients undergoing mayor surgery by laparotomy. However, a failure rate up to 30% has been reported resulting in inadequate analgesia with the necessity for using high amounts of opioids. Besides the misuse of opioids and the addictive effect already resulting in a ‘opioid crisis’ in the USA, opioid use in the post-operative setting is associated with nausea and vomiting, sedation, respiratory depression, obstipation, ileus and extended in-hospital stay. Furthermore, epidural analgesia is associated with hypotension, urinary retention, bladder disfunction and reduced mobilization post-surgery, and is contra-indicated in patients using anti-coagulant therapy (e.g. 17-38% of all ovarian cancer patients have venous thromboembolism). A new and innovative analgesic alternative are the pre-peritoneal wound catheters, with continuous infusion of local anesthetics in the wound after mayor surgery. Limited studies show that, in patients with colorectal or liver surgery, these wound catheters have been shown to result in adequate reduction of post-operative pain, less opioid consumption, a high patient satisfaction, less nausea and vomiting, earlier bowel movement, less obstipation, less hypotension, earlier mobilization out of bed, with no increase in complications. However, data in gynecological oncology patients are currently lacking.

Research question / problem definition
can pre-peritoneal wound catheters be a good analgesic alternative after mayor gynecological oncologic surgery compared to epidural analgesia, and does it have a beneficial effect on patient outcomes (pain scores, opiod use, nausea and vomiting scores, complications, length of stay).

Workplan
You will build an extensive and robust both retrospective and prospective clinical database with coded patient data (e.g. age, type of cancer, type of surgery, pain scores, nausea and vomiting scores, opioid use, length of in-hospital stay, complications). Data will be analyzed accordingly including statistical analyses, with the aim to report your findings in a peer-reviewed scientific journal.

References

1) Huang XZ et al. Continuous Wound Infiltration with Local Anesthetic Is an Effective and Safe Postoperative Analgesic Strategy: A Meta-Analysis. Pain Ther. 2021. 2) Gavriilidis P et al. Local anaesthetic infiltration via wound catheter versus epidural analgesia in open hepatectomy: a systematic review and meta-analysis of randomised controlled trials. HPB (Oxford). 2019. 3) Mungroop TH et al. Preperitoneal or Subcutaneous Wound Catheters as Alternative for Epidural Analgesia in Abdominal Surgery: A Systematic Review and Meta-analysis. Ann Surg. 2019. 4) Nelson et al. Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations—2019 update. BMJ, 2019.