Symptoms and General Pathology

All Conditions

Neoplasms

Urinary Tract, Sexual Organs, and Pregnancy Conditions

Pain, Postoperative

Urinary Bladder Neoplasms

Pain

Urologic Neoplasms

Urogenital Neoplasms

Urogenital Diseases

Female Urogenital Diseases

Pregnancy Complications

Female Urogenital Diseases and Pregnancy Complications

Urinary Bladder Diseases

Urologic Diseases

Male Urogenital Diseases

Central Nervous System Depressants

All Drugs and Chemicals

Analgesics

Herbal and Botanical

Anesthetics

Bupivacaine

Hydromorphone

Patients will have rectus sheath catheters surgically inserted with infusion of 0.125% Bupivicaine at 5mls an hour.

Patients will have a standard epidural placement with infusion of 0.125% Bupivicaine at an initial rate of 5mls/hour, titrated to response

Patients in this group will have an epidural inserted in a standard fashion, prior to the induction of anesthesia. These will be infused with 0.125% Bupivicaine at an initial rate of 5mls/hour, titrated to response. Patients will also receive a patient controlled analgesia with hydromorphone 0.2mg/ml, bolus of 200 micrograms with 6 minute lock out (variable in accordance with anesthetic preference).

Epidural

Patients in this group will have surgically inserted rectus sheath catheters (bilaterally), immediately prior to closure of the anterior abdominal wall. These will be infused with 0.125% Bupivicaine at 5mls an hour at a standard rate.Patients will also receive a patient controlled analgesia with hydromorphone 0.2mg/ml, bolus of 200 micrograms with 6 minute lock out (variable in accordance with anesthetic preference).

Rectus Sheath Catheters

Edmund CP Chedgy, MBBS,FRCS

Geneveive Lowe, MBBS

Edmund CP Chedgy, MBBS, FRCS

Genevieve Lowe, MBBS

Martin E Gleave, MD

This is a prospective randomised controlled trial that will compare the outcomes of rectus sheath catheters to epidurals in patients who have undergone a cystectomy, via a lower midline abdominal incision for bladder cancer.

This study will compare the outcomes of two different pain control techniques, used as standard of care, following major abdominal surgery for bladder removal. Rectus sheath catheters are small tubes that are positioned into a specific area of the cut abdominal wall at the end of surgery; whereas an epidural is a tube that is positioned into the back. Both allow administration of local anaesthetic for pain control. The current gold standard is an epidural. This study will aim to evaluate this and show the comparative efficacy of the rectus sheath catheter, which anecdotally the investigators have found superior in practice.

Comparing Rectus Sheath Catheter to Epidural Post Cystectomy

A Randomised Controlled Trial of Thoracic Epidural Analgesia Versus Surgically Placed Rectus Sheath Catheters for Open Radical Cystectomy: Is There a Difference in Patient Outcomes?

Opioid requirement will be measured in morphine equivalents and reported as such on a per patient basis and measured throughout the operation.

Measurement of individual patient fluid balance will be performed up to and including day 3 post-operatively.

Hypotension for the purposes of this study is defined as a systolic blood pressure of less than 95.

Ileus will be measured by a 3 separate variables - bowel sounds, passing of flatus and opening of bowels. The post-operative day on which each of these targets is achieved for each patient will be recorded.

Patient satisfaction with pain control will be measured using a 9-point Likert scale on day 3 post-operatively.

At 30 days an electronic note review will be performed to evaluate for 30 day mortality and morbidity.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization	Link
Comparing Rectus Sheath Catheter to Epidural Post Cystectomy	NCT02572804	Bladder Cancer Postoperative P...	Epidural Rectus Sheath C...	19 Years -	Vancouver Coastal Health
Comparing Rectus Sheath Catheter to Epidural Post Cystectomy	NCT02572804	Bladder Cancer Postoperative P...	Epidural Rectus Sheath C...	19 Years -	Vancouver Coastal Health

Spots Global Cancer Trial Database for rectus sheath catheters