Paravertebral Catheters for Pancreatic Surgery

Design: Level I randomized prospective outcomes study comparing two groups of patients. One group will receive buipvacanine and dilaudid thoracic epidural analgesia (PCA) post-operatively. The other will receive bilateral ultrasound guided paravertebral blocks with indwelling paravertebral catheters with an infusion of 0.2% ropivicaine post-operatively and a PCA.

Sample Size: 50 patients Study Duration: Approximately 12 months Population:. Patients presenting to the University of Minnesota Medical Center for elective open pancreatic surgery.

Primary Objective: To determine if bilateral paravertebral catheters in patients with open pancreatic procedures result in decreased total maximal pain scores compared to patients treated with thoracic epidural for post-operative pain.

Secondary Objectives:

• To determine whether the use of bilateral paravertebral catheters impacts the length of ICU and hospital stay for patients, compared to a thoracic epidurals in patients undergoing elective open pancreatic surgery.
• To determine whether the use of ultrasound guided bilateral paravertebral catheters leads to lower risk of complications, compared to use of a thoracic epidural in patients undergoing open pancreatic surgery.

• Synopsis and Medical Application:

Specific Aims:

Primary Hypothesis: Paravertebral catheters will result in improved pain control relative to thoracic epidural for post-operative pain from open pancreatic surgery.

Secondary Hypothesis: Paravertebral catheters will result in fewer hospital days and improved subjective respiratory function compared to patients in the thoracic epidural group.

Inclusion criteria

• • All patients undergoing open pancreatic surgery.

Exclusion criteria

• • Previous difficult airway or multiple previous intubations

• History of myasthenic syndrome
• Systemic infection
• Pre-existing sensory deficit
• PT >14 or PTT >40 sec
• Platelet count less than 50,000
• Creatinine > 1.5
• Allergy to local anesthetics
• Patients who remain intubated for one week after surgery or who are unable to provide information as to their feelings of pain post-operatively for the first week post-operatively
• Use of a spinal or epidural anesthetic for surgery
• Daily use of opioid for more than a week or chronic pain syndrome
• Lack of patient cooperation
• Contraindication to regional anesthesia

• Infection at injection site
• Inability to guarantee sterile equipment or sterile conditions for the block
• Patient refusal
• Risk of local anesthetic toxicity
• Coagulopathy or bleeding disorder
• Severe respiratory disease (where the patient depends on intercostal muscle function for ventilation);
• Ipsilateral diaphragmatic paresis;