title: Continuous epidural versus wound infusion plus single morphine bolus as postoperative analgesia in open abdominal aortic aneurysm repair: a randomized non-inferiority trial.
abstract: We compared a bundle of interventions including wound infiltration and continuous infusion with local anesthetics plus a single morphine bolus (CWI-M) with continuous epidural infusion (CEI) as postoperative analgesia.
  
  
  
  Fifty-one adults undergoing open abdominal aortic aneurysm repair were randomized in this non-inferiority open-label trial. In the CEI group, patients received thoracic epidural levobupivacaine 0.12% plus sufentanil 0.4 µg/mL infusion for 48 hours. In the CWI-M group, the wound was infiltrated with 10 mL levobupivacaine 0.5%, patients received a morphine bolus before the end of anesthesia and levobupivacaine 0.25% infusion through two multi-holed pre-peritoneal catheters for 48 hours. Systemic morphine was administered as rescue in both groups. The primary endpoint was the mean Numeric Rating Scale score in the first 48 hours after surgery.
  
  
  
  Mean NRS was 1.7 (95% CI: from 1.2 to 2.2) in the CEI and 2.2 (95% CI: from 1.7 to 2.7) in the CWI-M group, the 90% CI of difference was from -0.1 to 1.1, not including the non-inferiority margin of 1.3. The cumulative rescue morphine dose per patient was higher in CWI-M than in CEI group (3.7±4.4 vs. 0.8±2.4 mg, P=0.006); moreover, NRS at arousal was higher in CWI-M (P=0.003). No differences were observed in postoperative hemodynamic parameters, recovery-related outcomes, length of stay nor complications.
  
  
  
  CWI-M was comparable to CEI in in postoperative pain control, but it was associated with higher need of rescue systemic opiates and with a worse early pain control.
authors: Department of Surgery and Integrated Diagnostics, San Martino Hospital and Institute for Research and Care, University of Genoa, Genoa, Italy - lorenzo.ball@edu.unige.it.
authors: Lorenzo
authors: L
authors: Ball
authors: Department of Surgery and Integrated Diagnostics, San Martino Hospital and Institute for Research and Care, University of Genoa, Genoa, Italy.
authors: Giulia
authors: G
authors: Pellerano
authors: Department of Anesthesia and Resuscitation, San Martino Hospital and Institute for Research and Care, Genoa, Italy.
authors: Laura
authors: L
authors: Corsi
authors: Department of Anesthesia and Resuscitation, San Martino Hospital and Institute for Research and Care, Genoa, Italy.
authors: Nadia
authors: N
authors: Giudici
authors: Department of Anesthesia and Resuscitation, San Martino Hospital and Institute for Research and Care, Genoa, Italy.
authors: Anna
authors: A
authors: Pellegrino
authors: Department of Anesthesia and Resuscitation, San Martino Hospital and Institute for Research and Care, Genoa, Italy.
authors: Daniela
authors: D
authors: Cannata
authors: Department of Surgery and Integrated Diagnostics, San Martino Hospital and Institute for Research and Care, University of Genoa, Genoa, Italy.
authors: Gregorio
authors: G
authors: Santori
authors: Department of Surgery and Integrated Diagnostics, San Martino Hospital and Institute for Research and Care, University of Genoa, Genoa, Italy.
authors: Domenico
authors: D
authors: Palombo
authors: Department of Surgery and Integrated Diagnostics, San Martino Hospital and Institute for Research and Care, University of Genoa, Genoa, Italy.
authors: Paolo
authors: P
authors: Pelosi
authors: Department of Anesthesia and Resuscitation, San Martino Hospital and Institute for Research and Care, Genoa, Italy.
authors: Angelo
authors: A
authors: Gratarola
mesh_terms: D000368:Aged; D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D002045:Bupivacaine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D009020:Morphine / Q000008:administration & dosage*; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D002045:Bupivacaine