Continuous Wound Catheter Analgesia Associated With Intravenous Morphine PCA After Thoracotomy
Continuous Wound Catheter Analgesia Associated With Intravenous Morphine PCA After Thoracotomy
Objective: Epidural analgesia is the gold standard for post-thoracotomy pain relief but is
 contraindicated in certain patients. An alternative is continuous wound catheter analgesia.
 We will investigate whether ropivacaine, administered through a wound catheter placed by the
 surgeon, will reduce postoperative pain. Methods: In a randomized double-blind study, adult
 patients with a wound catheter placed by the thoracic surgeon after thoracotomy will be
 randomly assigned to receive through this catheter, either a 0.1 mL/kg bolus of 0.75%
 ropivacaine, followed by a continuous infusion of 0.2% ropivacaine at 10 mL/h for 48 h, or
 saline at the same scheme of administration. Patients will also benefit from
 patient-controlled analgesia with intravenous morphine (bolus 1 mg, lockout time 7 min),
 paracetamol, and nefopam. The primary endpoint will be total morphine consumption. Secondary
 endpoints will be pain intensity on a visual analog scale at rest and on coughing and side
 effects during the first 48 postoperative hours. Surgeons, anesthesiologists, and all the
 nurses and caring staff involved in this study will be blinded. Solutions of saline and
 ropivacaine will be prepared identically by the central pharmacy, without any possible
 identification of the product.
Inclusion Criteria:

 Patients scheduled for thoracotomy who presented with contraindications to TEA.

 Contraindications to TEA are :

 -  Patient's refusal after informations about advantages and risks of the technique

 -  Anti platelets treatment that can't be discontinued

 -  Anticoagulants at a curative dosage

 -  haemostasis and/or coagulation disorders: thrombopenia < 100.000/mm3, ACT > 1,5 /
 control, PTT < 75%

 -  Systemic or local infection of the puncture point

 -  2 and 3 grade atrio-ventricular heart block without pacing

 -  Severe aortic valve stenosis

 -  Kyphoscoliosis

 -  certain neurological disorders

 Exclusion Criteria:

 -  Patient's refusal to participate in the study

 -  Psychiatric disorder (impossibility to collect the informed consent)

 -  Patient under juridical protection

 -  On going an other study

 -  Pregnancy, breastfeeding

 -  Non balanced epilepsy

 -  3 grade auriculo-ventricular heart block without pacing

 -  Severe hepatocellular insufficiency

 -  Anti arrhythmic treatment : class III of the Vaughan William's classification

 -  Skin infection of the puncture point

 -  Allergy to aminoamides local anaesthetic

 -  Surgical difficulties to insert paravertebral catheter