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Poor recruitment
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The purpose of this study is to assess the effectiveness of transversus abdominal plane (TAP) block, thoracic epidural or paravertebral block (PVB) for controlling postoperative pain when compared with opioid you self-administer in your vein using a PCA device. The primary outcome will be postoperative opioid consumption within 24 hours after surgery. A total of 120 subjects will be randomized in a 1:1:1:1 ratio to receive a TAP block, PVB, TEA or no block (PCA alone).Patients in all groups will be cared for using an established enhanced recovery after surgery (ERAS) pathway incorporating a multimodal analgesic regimen using IV acetaminophen and postoperative PCA fentanyl.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Paravertebral block | Active Comparator | Bilateral PVB will be placed between T7-T10 interspaces preoperatively. Patients will be in a sitting position which allows easy identification of landmarks, and the patients are often more comfortable. Ultrasound will be used to identify the paravertebral space. At the appropriate dermatome under aseptic precautions, the needle (22-gauge, 8-10-cm short beveled spinal needle) will inserted 2.5-3 cm lateral to the most cephalad aspect of the spinous process and advanced perpendicular to the skin in all planes to contact the transverse process 3 of the vertebra below at a variable depth (2-4 cm). A 10 mL ropivacaine 0.25% will be injected at both T7 and T9 levels on each side (40 mL in total). |
|
| TAP block | Active Comparator | Bilateral posterior and subcostal TAP blocks guided by ultrasound will be performed in the preoperative holding area. A total of 80 mL ropivacaine 0.25% (4 injections, 20 mL per injection) will be injected evenly upon identification of the appropriate planes. In the event the placement of block is uncomfortable for the patients, it will be performed after induction of anesthesia. This approach is currently practiced in the OR. Extent and degree of anesthetic blockage will be measured using a 5-point sensation scale following the procedure at 4 areas on the anterior abdominal wall (above and below the umbilicus bilaterally). |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| TAP block | Procedure |
|
| |
| Epidural |
| Measure | Description | Time Frame |
|---|---|---|
| Postoperative Opioid Consumption | If opioid other than fentanyl is used, the dose will be converted to morphine equivalent. | 24 hours after surgery |
| Measure | Description | Time Frame |
|---|---|---|
| Pain Scores | Pain scores at rest and with activity using a verbal rating scales (VRS) of 0-10, where "0" represents no pain and "10" represents worst pain ever, at 30, 60, 90, 120 min and every 6 hours for 24 hours and every 12 hours for 48 hours and once a day thereafter until discharge. Data were collected at the indicated time points and an average pain score was calculated. | Participants will be followed for the duration of hospital stay, an estimated 1 week |
Not provided
Inclusion Criteria
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Duke University Medical Center | Durham | North Carolina | 27701 | United States |
Of the 17 patients that consented, one patient withdrew before randomization
Not provided
Not provided
| ID | Title | Description |
|---|---|---|
| FG000 | Paravertebral Block | Bilateral PVB will be placed between T7-T10 interspaces preoperatively. Patients will be in a sitting position which allows easy identification of landmarks, and the patients are often more comfortable. Ultrasound will be used to identify the paravertebral space. At the appropriate dermatome under aseptic precautions, the needle (22-gauge, 8-10-cm short beveled spinal needle) will inserted 2.5-3 cm lateral to the most cephalad aspect of the spinous process and advanced perpendicular to the skin in all planes to contact the transverse process 3 of the vertebra below at a variable depth (2-4 cm). A 10 mL ropivacaine 0.25% will be injected at both T7 and T9 levels on each side (40 mL in total). Paravertebral block Acetaminophen 1g IV Dexamethasone 4mg Midazolam up to 2mg Propofol 1-2.5 mg/kg Sevoflurane to keep a bispectral index of between 40-60 Local infiltration with 10 mL of plain ropivacaine 0.25% |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Overall Study |
|
Not provided
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| Epidural |
| Active Comparator |
An epidural catheter will be inserted between T8-10 in the preoperative holding area, and a test dose of 1.5% lidocaine with 1:200,000 epinephrine will be given. Extent and degree of anesthetic blockage will be measured using a 5-point sensation following the procedure and postoperatively at 4 areas on the anterior abdominal wall (above and below the umbilicus bilaterally). A bolus does of epidural hydromorphone (400-800 mcg) will be given preoperatively. An infusion of bupivacaine 0.25% at 4-6 ml/hour will be commenced before incision, and if tolerated, continued throughout surgery. Adjustments that may be required secondary to specific patient hemodynamic status will be left to the discretion of the individual anesthesiologist and guided by the specific patient requirements. |
|
| No block (PCA alone) | Active Comparator | Premedication with midazolam up to 2 mg. General anesthesia is induced with propofol 1-2.5 mg/kg. Dexamethasone 4 mg IV will be administered after induction of anesthesia. Anesthesia will be maintained with sevoflurane to keep a bispectral index of between 40-60. Neuromuscular blocking drug and reversal agent of choice may be used. Local infiltration with 10 mL of plain ropivacaine 0.25% will be administered at the surgical incision site at the end of surgery. Acetaminophen 1g IV will be administered following induction of anesthesia will be administered at the end of the procedure |
|
| Procedure |
|
|
| Paravertebral block | Procedure |
|
|
| Acetaminophen 1g IV | Drug |
|
| Dexamethasone 4mg | Drug |
|
| Midazolam up to 2mg | Drug |
|
| Propofol 1-2.5 mg/kg | Drug |
|
| Sevoflurane to keep a bispectral index of between 40-60 | Drug |
|
| Local infiltration with 10 mL of plain ropivacaine 0.25% | Drug |
|
| Lidocaine | Drug | 1.5% lidocaine |
|
| Epinephrine | Drug | 1:200,000 epinephrine |
|
| Hydromorphone | Drug | 400-800 mcg Hydromorphone will be given preoperatively |
|
| Quality of Recovery | Quality of Recovery Score (QoR-15) is measured on a scale of 0-150 (0=poor, 150 = excellent). Scores were collected daily for 72 hours and then averaged. | 72 hours |
| Complications as Measured by a Modified Postoperative Morbidity Survey (MPMS) | Complications using a Modified Postoperative Morbidity Survey (MPMS) | Participants will be followed for the duration of hospital stay, an estimated 1 week |
| Time to First Bowel Movement | Participants will be followed for the duration of hospital stay, an estimated 1 week |
| Opioid Related Side Effects | Occurrence and duration of opioid related adverse events including postoperative nausea and vomiting (PONV); pruritus, urinary retention, confusion, sedation and respiratory depression at the above time points. | Participants will be followed for the duration of hospital stay, an estimated 1 week |
| Time to First Ingestion of Solid Food | Participants will be followed for the duration of hospital stay, an estimated 1 week |
| Number of Epidural-related Side Effects | Participants will be followed for the duration of hospital stay, an estimated 1 week |
| Length of Stay | Participants will be followed for the duration of hospital stay, an estimated 1 week |
| FG001 | TAP Block | Bilateral posterior and subcostal TAP blocks guided by ultrasound will be performed in the preoperative holding area. A total of 80 mL ropivacaine 0.25% (4 injections, 20 mL per injection) will be injected evenly upon identification of the appropriate planes. In the event the placement of block is uncomfortable for the patients, it will be performed after induction of anesthesia. This approach is currently practiced in the OR. Extent and degree of anesthetic blockage will be measured using a 5-point sensation scale following the procedure at 4 areas on the anterior abdominal wall (above and below the umbilicus bilaterally). TAP block Acetaminophen 1g IV Dexamethasone 4mg Midazolam up to 2mg Propofol 1-2.5 mg/kg Sevoflurane to keep a bispectral index of between 40-60 Local infiltration with 10 mL of plain ropivacaine 0.25% |
| FG002 | Epidural | An epidural catheter will be inserted between T8-10 in the preoperative holding area, and a test dose of 1.5% lidocaine with 1:200,000 epinephrine will be given. Extent and degree of anesthetic blockage will be measured using a 5-point sensation following the procedure and postoperatively at 4 areas on the anterior abdominal wall (above and below the umbilicus bilaterally). A bolus does of epidural hydromorphone (400-800 mcg) will be given preoperatively. An infusion of bupivacaine 0.25% at 4-6 ml/hour will be commenced before incision, and if tolerated, continued throughout surgery. Adjustments that may be required secondary to specific patient hemodynamic status will be left to the discretion of the individual anesthesiologist and guided by the specific patient requirements. Epidural Acetaminophen 1g IV Dexamethasone 4mg Midazolam up to 2mg Propofol 1-2.5 mg/kg Sevoflurane to keep a bispectral index of between 40-60 Local infiltration with 10 mL of plain ropi |
| FG003 | No Block (PCA Alone) | Premedication with midazolam up to 2 mg. General anesthesia is induced with propofol 1-2.5 mg/kg. Dexamethasone 4 mg IV will be administered after induction of anesthesia. Anesthesia will be maintained with sevoflurane to keep a bispectral index of between 40-60. Neuromuscular blocking drug and reversal agent of choice may be used. Local infiltration with 10 mL of plain ropivacaine 0.25% will be administered at the surgical incision site at the end of surgery. Acetaminophen 1g IV will be administered following induction of anesthesia will be administered at the end of the procedure Acetaminophen 1g IV Dexamethasone 4mg Midazolam up to 2mg Propofol 1-2.5 mg/kg Sevoflurane to keep a bispectral index of between 40-60 Local infiltration with 10 mL of plain ropivacaine 0.25% |
| COMPLETED |
|
| NOT COMPLETED |
|
|
Participants that completed the study
Not provided
| ID | Title | Description |
|---|---|---|
| BG000 | Paravertebral Block | Bilateral PVB will be placed between T7-T10 interspaces preoperatively. Patients will be in a sitting position which allows easy identification of landmarks, and the patients are often more comfortable. Ultrasound will be used to identify the paravertebral space. At the appropriate dermatome under aseptic precautions, the needle (22-gauge, 8-10-cm short beveled spinal needle) will inserted 2.5-3 cm lateral to the most cephalad aspect of the spinous process and advanced perpendicular to the skin in all planes to contact the transverse process 3 of the vertebra below at a variable depth (2-4 cm). A 10 mL ropivacaine 0.25% will be injected at both T7 and T9 levels on each side (40 mL in total). Paravertebral block Acetaminophen 1g IV Dexamethasone 4mg Midazolam up to 2mg Propofol 1-2.5 mg/kg Sevoflurane to keep a bispectral index of between 40-60 Local infiltration with 10 mL of plain ropivacaine 0.25% |
| BG001 | TAP Block | Bilateral posterior and subcostal TAP blocks guided by ultrasound will be performed in the preoperative holding area. A total of 80 mL ropivacaine 0.25% (4 injections, 20 mL per injection) will be injected evenly upon identification of the appropriate planes. In the event the placement of block is uncomfortable for the patients, it will be performed after induction of anesthesia. This approach is currently practiced in the OR. Extent and degree of anesthetic blockage will be measured using a 5-point sensation scale following the procedure at 4 areas on the anterior abdominal wall (above and below the umbilicus bilaterally). TAP block Acetaminophen 1g IV Dexamethasone 4mg Midazolam up to 2mg Propofol 1-2.5 mg/kg Sevoflurane to keep a bispectral index of between 40-60 Local infiltration with 10 mL of plain ropivacaine 0.25% |
| BG002 | Epidural | An epidural catheter will be inserted between T8-10 in the preoperative holding area, and a test dose of 1.5% lidocaine with 1:200,000 epinephrine will be given. Extent and degree of anesthetic blockage will be measured using a 5-point sensation following the procedure and postoperatively at 4 areas on the anterior abdominal wall (above and below the umbilicus bilaterally). A bolus does of epidural hydromorphone (400-800 mcg) will be given preoperatively. An infusion of bupivacaine 0.25% at 4-6 ml/hour will be commenced before incision, and if tolerated, continued throughout surgery. Adjustments that may be required secondary to specific patient hemodynamic status will be left to the discretion of the individual anesthesiologist and guided by the specific patient requirements. Epidural Acetaminophen 1g IV Dexamethasone 4mg Midazolam up to 2mg Propofol 1-2.5 mg/kg Sevoflurane to keep a bispectral index of between 40-60 Local infiltration with 10 mL of plain ropi |
| BG003 | No Block (PCA Alone) | Premedication with midazolam up to 2 mg. General anesthesia is induced with propofol 1-2.5 mg/kg. Dexamethasone 4 mg IV will be administered after induction of anesthesia. Anesthesia will be maintained with sevoflurane to keep a bispectral index of between 40-60. Neuromuscular blocking drug and reversal agent of choice may be used. Local infiltration with 10 mL of plain ropivacaine 0.25% will be administered at the surgical incision site at the end of surgery. Acetaminophen 1g IV will be administered following induction of anesthesia will be administered at the end of the procedure Acetaminophen 1g IV Dexamethasone 4mg Midazolam up to 2mg Propofol 1-2.5 mg/kg Sevoflurane to keep a bispectral index of between 40-60 Local infiltration with 10 mL of plain ropivacaine 0.25% |
| BG004 | Total | Total of all reporting groups |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean | Standard Deviation | years |
| |||||||||||||||
| Sex: Female, Male | Count of Participants | Participants |
|
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Postoperative Opioid Consumption | If opioid other than fentanyl is used, the dose will be converted to morphine equivalent. | Posted | Mean | Standard Deviation | mcg | 24 hours after surgery |
|
|
| |||||||||||||||||||||||||||||||||||
| Secondary | Pain Scores | Pain scores at rest and with activity using a verbal rating scales (VRS) of 0-10, where "0" represents no pain and "10" represents worst pain ever, at 30, 60, 90, 120 min and every 6 hours for 24 hours and every 12 hours for 48 hours and once a day thereafter until discharge. Data were collected at the indicated time points and an average pain score was calculated. | Posted | Mean | Standard Deviation | Units on a scale | Participants will be followed for the duration of hospital stay, an estimated 1 week |
| |||||||||||||||||||||||||||||||||||||
| Secondary | Quality of Recovery | Quality of Recovery Score (QoR-15) is measured on a scale of 0-150 (0=poor, 150 = excellent). Scores were collected daily for 72 hours and then averaged. | Posted | Mean | Standard Deviation | Units on a scale | 72 hours |
| |||||||||||||||||||||||||||||||||||||
| Secondary | Complications as Measured by a Modified Postoperative Morbidity Survey (MPMS) | Complications using a Modified Postoperative Morbidity Survey (MPMS) | Data not collected | Posted | Participants will be followed for the duration of hospital stay, an estimated 1 week |
| |||||||||||||||||||||||||||||||||||||||
| Secondary | Time to First Bowel Movement | Posted | Mean | Standard Deviation | days | Participants will be followed for the duration of hospital stay, an estimated 1 week |
| ||||||||||||||||||||||||||||||||||||||
| Secondary | Opioid Related Side Effects | Occurrence and duration of opioid related adverse events including postoperative nausea and vomiting (PONV); pruritus, urinary retention, confusion, sedation and respiratory depression at the above time points. | Posted | Number | side effects | Participants will be followed for the duration of hospital stay, an estimated 1 week |
| ||||||||||||||||||||||||||||||||||||||
| Secondary | Time to First Ingestion of Solid Food | Posted | Mean | Standard Deviation | Days | Participants will be followed for the duration of hospital stay, an estimated 1 week |
| ||||||||||||||||||||||||||||||||||||||
| Secondary | Number of Epidural-related Side Effects | Posted | Number | Number of side effects | Participants will be followed for the duration of hospital stay, an estimated 1 week |
| |||||||||||||||||||||||||||||||||||||||
| Secondary | Length of Stay | Posted | Mean | Standard Deviation | Days | Participants will be followed for the duration of hospital stay, an estimated 1 week |
|
Not provided
Not provided
Not provided
| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Paravertebral Block | Bilateral PVB will be placed between T7-T10 interspaces preoperatively. Patients will be in a sitting position which allows easy identification of landmarks, and the patients are often more comfortable. Ultrasound will be used to identify the paravertebral space. At the appropriate dermatome under aseptic precautions, the needle (22-gauge, 8-10-cm short beveled spinal needle) will inserted 2.5-3 cm lateral to the most cephalad aspect of the spinous process and advanced perpendicular to the skin in all planes to contact the transverse process 3 of the vertebra below at a variable depth (2-4 cm). A 10 mL ropivacaine 0.25% will be injected at both T7 and T9 levels on each side (40 mL in total). Paravertebral block Acetaminophen 1g IV Dexamethasone 4mg Midazolam up to 2mg Propofol 1-2.5 mg/kg Sevoflurane to keep a bispectral index of between 40-60 Local infiltration with 10 mL of plain ropivacaine 0.25% | 0 | 4 | 0 | 4 | ||
| EG001 | TAP Block | Bilateral posterior and subcostal TAP blocks guided by ultrasound will be performed in the preoperative holding area. A total of 80 mL ropivacaine 0.25% (4 injections, 20 mL per injection) will be injected evenly upon identification of the appropriate planes. In the event the placement of block is uncomfortable for the patients, it will be performed after induction of anesthesia. This approach is currently practiced in the OR. Extent and degree of anesthetic blockage will be measured using a 5-point sensation scale following the procedure at 4 areas on the anterior abdominal wall (above and below the umbilicus bilaterally). TAP block Acetaminophen 1g IV Dexamethasone 4mg Midazolam up to 2mg Propofol 1-2.5 mg/kg Sevoflurane to keep a bispectral index of between 40-60 Local infiltration with 10 mL of plain ropivacaine 0.25% | 0 | 3 | 0 | 3 | ||
| EG002 | Epidural | An epidural catheter will be inserted between T8-10 in the preoperative holding area, and a test dose of 1.5% lidocaine with 1:200,000 epinephrine will be given. Extent and degree of anesthetic blockage will be measured using a 5-point sensation following the procedure and postoperatively at 4 areas on the anterior abdominal wall (above and below the umbilicus bilaterally). A bolus does of epidural hydromorphone (400-800 mcg) will be given preoperatively. An infusion of bupivacaine 0.25% at 4-6 ml/hour will be commenced before incision, and if tolerated, continued throughout surgery. Adjustments that may be required secondary to specific patient hemodynamic status will be left to the discretion of the individual anesthesiologist and guided by the specific patient requirements. Epidural Acetaminophen 1g IV Dexamethasone 4mg Midazolam up to 2mg Propofol 1-2.5 mg/kg Sevoflurane to keep a bispectral index of between 40-60 Local infiltration with 10 mL of plain ropi | 0 | 4 | 0 | 4 | ||
| EG003 | No Block (PCA Alone) | Premedication with midazolam up to 2 mg. General anesthesia is induced with propofol 1-2.5 mg/kg. Dexamethasone 4 mg IV will be administered after induction of anesthesia. Anesthesia will be maintained with sevoflurane to keep a bispectral index of between 40-60. Neuromuscular blocking drug and reversal agent of choice may be used. Local infiltration with 10 mL of plain ropivacaine 0.25% will be administered at the surgical incision site at the end of surgery. Acetaminophen 1g IV will be administered following induction of anesthesia will be administered at the end of the procedure Acetaminophen 1g IV Dexamethasone 4mg Midazolam up to 2mg Propofol 1-2.5 mg/kg Sevoflurane to keep a bispectral index of between 40-60 Local infiltration with 10 mL of plain ropivacaine 0.25% | 0 | 4 | 0 | 4 |
Not provided
Not provided
Not provided
Not provided
Not provided
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Timothy Miller, MD | Duke University Medical Center | timothy.miller2@duke.edu |
| ID | Term |
|---|---|
| D007268 | Injections, Epidural |
| D000082 | Acetaminophen |
| D003907 | Dexamethasone |
| D015742 | Propofol |
| D008012 | Lidocaine |
| D004837 | Epinephrine |
| D004091 | Hydromorphone |
| ID | Term |
|---|---|
| D007278 | Injections, Spinal |
| D007267 | Injections |
| D004333 | Drug Administration Routes |
| D004358 | Drug Therapy |
| D013812 | Therapeutics |
| D000083 | Acetanilides |
| D000813 | Anilides |
| D000577 | Amides |
| D009930 | Organic Chemicals |
| D000814 | Aniline Compounds |
| D000588 | Amines |
| D011246 | Pregnadienetriols |
| D011245 | Pregnadienes |
| D011278 | Pregnanes |
| D013256 | Steroids |
| D000072473 | Fused-Ring Compounds |
| D011083 | Polycyclic Compounds |
| D013259 | Steroids, Fluorinated |
| D010636 | Phenols |
| D001555 | Benzene Derivatives |
| D006841 | Hydrocarbons, Aromatic |
| D006844 | Hydrocarbons, Cyclic |
| D006838 | Hydrocarbons |
| D004983 | Ethanolamines |
| D000605 | Amino Alcohols |
| D000438 | Alcohols |
| D015306 | Biogenic Monoamines |
| D001679 | Biogenic Amines |
| D002395 | Catecholamines |
| D002396 | Catechols |
| D009022 | Morphine Derivatives |
| D009019 | Morphinans |
| D053610 | Opiate Alkaloids |
| D000470 | Alkaloids |
| D006571 | Heterocyclic Compounds |
| D006572 | Heterocyclic Compounds, Bridged-Ring |
| D006576 | Heterocyclic Compounds, 4 or More Rings |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D010616 | Phenanthrenes |
| D011084 | Polycyclic Aromatic Hydrocarbons |
Not provided
Not provided
| Male |
|
| OG002 | Epidural | An epidural catheter will be inserted between T8-10 in the preoperative holding area, and a test dose of 1.5% lidocaine with 1:200,000 epinephrine will be given. Extent and degree of anesthetic blockage will be measured using a 5-point sensation following the procedure and postoperatively at 4 areas on the anterior abdominal wall (above and below the umbilicus bilaterally). A bolus does of epidural hydromorphone (400-800 mcg) will be given preoperatively. An infusion of bupivacaine 0.25% at 4-6 ml/hour will be commenced before incision, and if tolerated, continued throughout surgery. Adjustments that may be required secondary to specific patient hemodynamic status will be left to the discretion of the individual anesthesiologist and guided by the specific patient requirements. Epidural Acetaminophen 1g IV Dexamethasone 4mg Midazolam up to 2mg Propofol 1-2.5 mg/kg Sevoflurane to keep a bispectral index of between 40-60 Local infiltration with 10 mL of plain ropi |
| OG003 | No Block (PCA Alone) | Premedication with midazolam up to 2 mg. General anesthesia is induced with propofol 1-2.5 mg/kg. Dexamethasone 4 mg IV will be administered after induction of anesthesia. Anesthesia will be maintained with sevoflurane to keep a bispectral index of between 40-60. Neuromuscular blocking drug and reversal agent of choice may be used. Local infiltration with 10 mL of plain ropivacaine 0.25% will be administered at the surgical incision site at the end of surgery. Acetaminophen 1g IV will be administered following induction of anesthesia will be administered at the end of the procedure Acetaminophen 1g IV Dexamethasone 4mg Midazolam up to 2mg Propofol 1-2.5 mg/kg Sevoflurane to keep a bispectral index of between 40-60 Local infiltration with 10 mL of plain ropivacaine 0.25% |
|
|
| OG002 | Epidural | An epidural catheter will be inserted between T8-10 in the preoperative holding area, and a test dose of 1.5% lidocaine with 1:200,000 epinephrine will be given. Extent and degree of anesthetic blockage will be measured using a 5-point sensation following the procedure and postoperatively at 4 areas on the anterior abdominal wall (above and below the umbilicus bilaterally). A bolus does of epidural hydromorphone (400-800 mcg) will be given preoperatively. An infusion of bupivacaine 0.25% at 4-6 ml/hour will be commenced before incision, and if tolerated, continued throughout surgery. Adjustments that may be required secondary to specific patient hemodynamic status will be left to the discretion of the individual anesthesiologist and guided by the specific patient requirements. Epidural Acetaminophen 1g IV Dexamethasone 4mg Midazolam up to 2mg Propofol 1-2.5 mg/kg Sevoflurane to keep a bispectral index of between 40-60 Local infiltration with 10 mL of plain ropi |
| OG003 | No Block (PCA Alone) | Premedication with midazolam up to 2 mg. General anesthesia is induced with propofol 1-2.5 mg/kg. Dexamethasone 4 mg IV will be administered after induction of anesthesia. Anesthesia will be maintained with sevoflurane to keep a bispectral index of between 40-60. Neuromuscular blocking drug and reversal agent of choice may be used. Local infiltration with 10 mL of plain ropivacaine 0.25% will be administered at the surgical incision site at the end of surgery. Acetaminophen 1g IV will be administered following induction of anesthesia will be administered at the end of the procedure Acetaminophen 1g IV Dexamethasone 4mg Midazolam up to 2mg Propofol 1-2.5 mg/kg Sevoflurane to keep a bispectral index of between 40-60 Local infiltration with 10 mL of plain ropivacaine 0.25% |
|
|
| OG002 | Epidural | An epidural catheter will be inserted between T8-10 in the preoperative holding area, and a test dose of 1.5% lidocaine with 1:200,000 epinephrine will be given. Extent and degree of anesthetic blockage will be measured using a 5-point sensation following the procedure and postoperatively at 4 areas on the anterior abdominal wall (above and below the umbilicus bilaterally). A bolus does of epidural hydromorphone (400-800 mcg) will be given preoperatively. An infusion of bupivacaine 0.25% at 4-6 ml/hour will be commenced before incision, and if tolerated, continued throughout surgery. Adjustments that may be required secondary to specific patient hemodynamic status will be left to the discretion of the individual anesthesiologist and guided by the specific patient requirements. Epidural Acetaminophen 1g IV Dexamethasone 4mg Midazolam up to 2mg Propofol 1-2.5 mg/kg Sevoflurane to keep a bispectral index of between 40-60 Local infiltration with 10 mL of plain ropi |
| OG003 | No Block (PCA Alone) | Premedication with midazolam up to 2 mg. General anesthesia is induced with propofol 1-2.5 mg/kg. Dexamethasone 4 mg IV will be administered after induction of anesthesia. Anesthesia will be maintained with sevoflurane to keep a bispectral index of between 40-60. Neuromuscular blocking drug and reversal agent of choice may be used. Local infiltration with 10 mL of plain ropivacaine 0.25% will be administered at the surgical incision site at the end of surgery. Acetaminophen 1g IV will be administered following induction of anesthesia will be administered at the end of the procedure Acetaminophen 1g IV Dexamethasone 4mg Midazolam up to 2mg Propofol 1-2.5 mg/kg Sevoflurane to keep a bispectral index of between 40-60 Local infiltration with 10 mL of plain ropivacaine 0.25% |
|
| OG002 | Epidural | An epidural catheter will be inserted between T8-10 in the preoperative holding area, and a test dose of 1.5% lidocaine with 1:200,000 epinephrine will be given. Extent and degree of anesthetic blockage will be measured using a 5-point sensation following the procedure and postoperatively at 4 areas on the anterior abdominal wall (above and below the umbilicus bilaterally). A bolus does of epidural hydromorphone (400-800 mcg) will be given preoperatively. An infusion of bupivacaine 0.25% at 4-6 ml/hour will be commenced before incision, and if tolerated, continued throughout surgery. Adjustments that may be required secondary to specific patient hemodynamic status will be left to the discretion of the individual anesthesiologist and guided by the specific patient requirements. Epidural Acetaminophen 1g IV Dexamethasone 4mg Midazolam up to 2mg Propofol 1-2.5 mg/kg Sevoflurane to keep a bispectral index of between 40-60 Local infiltration with 10 mL of plain ropi |
| OG003 | No Block (PCA Alone) | Premedication with midazolam up to 2 mg. General anesthesia is induced with propofol 1-2.5 mg/kg. Dexamethasone 4 mg IV will be administered after induction of anesthesia. Anesthesia will be maintained with sevoflurane to keep a bispectral index of between 40-60. Neuromuscular blocking drug and reversal agent of choice may be used. Local infiltration with 10 mL of plain ropivacaine 0.25% will be administered at the surgical incision site at the end of surgery. Acetaminophen 1g IV will be administered following induction of anesthesia will be administered at the end of the procedure Acetaminophen 1g IV Dexamethasone 4mg Midazolam up to 2mg Propofol 1-2.5 mg/kg Sevoflurane to keep a bispectral index of between 40-60 Local infiltration with 10 mL of plain ropivacaine 0.25% |
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| OG002 | Epidural | An epidural catheter will be inserted between T8-10 in the preoperative holding area, and a test dose of 1.5% lidocaine with 1:200,000 epinephrine will be given. Extent and degree of anesthetic blockage will be measured using a 5-point sensation following the procedure and postoperatively at 4 areas on the anterior abdominal wall (above and below the umbilicus bilaterally). A bolus does of epidural hydromorphone (400-800 mcg) will be given preoperatively. An infusion of bupivacaine 0.25% at 4-6 ml/hour will be commenced before incision, and if tolerated, continued throughout surgery. Adjustments that may be required secondary to specific patient hemodynamic status will be left to the discretion of the individual anesthesiologist and guided by the specific patient requirements. Epidural Acetaminophen 1g IV Dexamethasone 4mg Midazolam up to 2mg Propofol 1-2.5 mg/kg Sevoflurane to keep a bispectral index of between 40-60 Local infiltration with 10 mL of plain ropi |
| OG003 | No Block (PCA Alone) | Premedication with midazolam up to 2 mg. General anesthesia is induced with propofol 1-2.5 mg/kg. Dexamethasone 4 mg IV will be administered after induction of anesthesia. Anesthesia will be maintained with sevoflurane to keep a bispectral index of between 40-60. Neuromuscular blocking drug and reversal agent of choice may be used. Local infiltration with 10 mL of plain ropivacaine 0.25% will be administered at the surgical incision site at the end of surgery. Acetaminophen 1g IV will be administered following induction of anesthesia will be administered at the end of the procedure Acetaminophen 1g IV Dexamethasone 4mg Midazolam up to 2mg Propofol 1-2.5 mg/kg Sevoflurane to keep a bispectral index of between 40-60 Local infiltration with 10 mL of plain ropivacaine 0.25% |
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| OG002 | Epidural | An epidural catheter will be inserted between T8-10 in the preoperative holding area, and a test dose of 1.5% lidocaine with 1:200,000 epinephrine will be given. Extent and degree of anesthetic blockage will be measured using a 5-point sensation following the procedure and postoperatively at 4 areas on the anterior abdominal wall (above and below the umbilicus bilaterally). A bolus does of epidural hydromorphone (400-800 mcg) will be given preoperatively. An infusion of bupivacaine 0.25% at 4-6 ml/hour will be commenced before incision, and if tolerated, continued throughout surgery. Adjustments that may be required secondary to specific patient hemodynamic status will be left to the discretion of the individual anesthesiologist and guided by the specific patient requirements. Epidural Acetaminophen 1g IV Dexamethasone 4mg Midazolam up to 2mg Propofol 1-2.5 mg/kg Sevoflurane to keep a bispectral index of between 40-60 Local infiltration with 10 mL of plain ropi |
| OG003 | No Block (PCA Alone) | Premedication with midazolam up to 2 mg. General anesthesia is induced with propofol 1-2.5 mg/kg. Dexamethasone 4 mg IV will be administered after induction of anesthesia. Anesthesia will be maintained with sevoflurane to keep a bispectral index of between 40-60. Neuromuscular blocking drug and reversal agent of choice may be used. Local infiltration with 10 mL of plain ropivacaine 0.25% will be administered at the surgical incision site at the end of surgery. Acetaminophen 1g IV will be administered following induction of anesthesia will be administered at the end of the procedure Acetaminophen 1g IV Dexamethasone 4mg Midazolam up to 2mg Propofol 1-2.5 mg/kg Sevoflurane to keep a bispectral index of between 40-60 Local infiltration with 10 mL of plain ropivacaine 0.25% |
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| OG002 | Epidural | An epidural catheter will be inserted between T8-10 in the preoperative holding area, and a test dose of 1.5% lidocaine with 1:200,000 epinephrine will be given. Extent and degree of anesthetic blockage will be measured using a 5-point sensation following the procedure and postoperatively at 4 areas on the anterior abdominal wall (above and below the umbilicus bilaterally). A bolus does of epidural hydromorphone (400-800 mcg) will be given preoperatively. An infusion of bupivacaine 0.25% at 4-6 ml/hour will be commenced before incision, and if tolerated, continued throughout surgery. Adjustments that may be required secondary to specific patient hemodynamic status will be left to the discretion of the individual anesthesiologist and guided by the specific patient requirements. Epidural Acetaminophen 1g IV Dexamethasone 4mg Midazolam up to 2mg Propofol 1-2.5 mg/kg Sevoflurane to keep a bispectral index of between 40-60 Local infiltration with 10 mL of plain ropi |
| OG003 | No Block (PCA Alone) | Premedication with midazolam up to 2 mg. General anesthesia is induced with propofol 1-2.5 mg/kg. Dexamethasone 4 mg IV will be administered after induction of anesthesia. Anesthesia will be maintained with sevoflurane to keep a bispectral index of between 40-60. Neuromuscular blocking drug and reversal agent of choice may be used. Local infiltration with 10 mL of plain ropivacaine 0.25% will be administered at the surgical incision site at the end of surgery. Acetaminophen 1g IV will be administered following induction of anesthesia will be administered at the end of the procedure Acetaminophen 1g IV Dexamethasone 4mg Midazolam up to 2mg Propofol 1-2.5 mg/kg Sevoflurane to keep a bispectral index of between 40-60 Local infiltration with 10 mL of plain ropivacaine 0.25% |
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| OG002 | Epidural | An epidural catheter will be inserted between T8-10 in the preoperative holding area, and a test dose of 1.5% lidocaine with 1:200,000 epinephrine will be given. Extent and degree of anesthetic blockage will be measured using a 5-point sensation following the procedure and postoperatively at 4 areas on the anterior abdominal wall (above and below the umbilicus bilaterally). A bolus does of epidural hydromorphone (400-800 mcg) will be given preoperatively. An infusion of bupivacaine 0.25% at 4-6 ml/hour will be commenced before incision, and if tolerated, continued throughout surgery. Adjustments that may be required secondary to specific patient hemodynamic status will be left to the discretion of the individual anesthesiologist and guided by the specific patient requirements. Epidural Acetaminophen 1g IV Dexamethasone 4mg Midazolam up to 2mg Propofol 1-2.5 mg/kg Sevoflurane to keep a bispectral index of between 40-60 Local infiltration with 10 mL of plain ropi |
| OG003 | No Block (PCA Alone) | Premedication with midazolam up to 2 mg. General anesthesia is induced with propofol 1-2.5 mg/kg. Dexamethasone 4 mg IV will be administered after induction of anesthesia. Anesthesia will be maintained with sevoflurane to keep a bispectral index of between 40-60. Neuromuscular blocking drug and reversal agent of choice may be used. Local infiltration with 10 mL of plain ropivacaine 0.25% will be administered at the surgical incision site at the end of surgery. Acetaminophen 1g IV will be administered following induction of anesthesia will be administered at the end of the procedure Acetaminophen 1g IV Dexamethasone 4mg Midazolam up to 2mg Propofol 1-2.5 mg/kg Sevoflurane to keep a bispectral index of between 40-60 Local infiltration with 10 mL of plain ropivacaine 0.25% |
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