title: Medial open transversus abdominis plane (MOTAP) catheters for analgesia following open liver resection: study protocol for a randomized controlled trial.
abstract: BACKGROUND
  The current standard for pain control following liver surgery is intravenous, patient-controlled analgesia (IV PCA) or epidural analgesia. We have developed a modification of a regional technique called medial open transversus abdominis plane (MOTAP) catheter analgesia. The MOTAP technique involves surgically placed catheters through the open surgical site into a plane between the internal oblique muscle and the transverse abdominis muscle superiorly. The objective of this trial is to assess the efficacy of this technique.
  
  
  METHODS
  This protocol describes a multicentre, prospective, blinded, randomized controlled trial. One hundred and twenty patients scheduled for open liver resection through a subcostal incision will be enrolled. All patients will have two MOTAP catheters placed at the conclusion of surgery. Patients will be randomized to one of two parallel groups: experimental (local anaesthetic through MOTAP catheters) or placebo (normal saline through MOTAP catheters). Both groups will also receive IV PCA. The primary endpoint is mean cumulative postoperative opioid consumption over the first 2 postoperative days (48 hours). Secondary outcomes include pain intensity, patient functional outcomes, and the incidence of complications.
  
  
  CONCLUSIONS
  This trial has been approved by the ethics boards at participating centres and is currently enrolling patients. Data collection will be completed by the end of 2014 with analysis mid-2015 and publication by the end of 2015.
  
  
  BACKGROUND
  The study is registered with http://clinicaltrials.gov ( NCT01960049; 23 September 2013).
authors.affiliation: Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada. paul.karanicolas@sunnybrook.ca.
authors.forename: Paul
authors.initials: P
authors.lastname: Karanicolas
authors.forename: Sean
authors.initials: S
authors.lastname: Cleary
authors.forename: Paul
authors.initials: P
authors.lastname: McHardy
authors.forename: Stuart
authors.initials: S
authors.lastname: McCluskey
authors.forename: Jason
authors.initials: J
authors.lastname: Sawyer
authors.forename: Salima
authors.initials: S
authors.lastname: Ladak
authors.forename: Calvin
authors.initials: C
authors.lastname: Law
authors.forename: Alice
authors.initials: A
authors.lastname: Wei
authors.forename: Natalie
authors.initials: N
authors.lastname: Coburn
authors.forename: Raynauld
authors.initials: R
authors.lastname: Ko
authors.forename: Joel
authors.initials: J
authors.lastname: Katz
authors.forename: Alex
authors.initials: A
authors.lastname: Kiss
authors.forename: James
authors.initials: J
authors.lastname: Khan
authors.forename: Srinivas
authors.initials: S
authors.lastname: Coimbatore
authors.forename: Jenny
authors.initials: J
authors.lastname: Lam-McCulloch
authors.forename: Hance
authors.initials: H
authors.lastname: Clarke
mesh_terms: D034841:Abdominal Cavity / Q000601:surgery; D000009:Abdominal Muscles / Q000601:surgery*; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000772:Anesthesia, Local / Q000379:methods*; D002404:Catheterization / Q000379:methods; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D007275:Injections, Intravenous; D008099:Liver / Q000601:surgery; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D012107:Research Design
chemical_list: D000701:Analgesics, Opioid