Risk of Failed Epidural in Patients With and Without Chronic Pain and Opioid Use

NCT ID: NCT05662566

Last Updated: 2025-04-06

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

150 participants

Study Classification

OBSERVATIONAL

Study Start Date

2023-03-17

Study Completion Date

2025-04-02

Brief Summary

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Patients with chronic pain syndrome (CPS) may develop central sensitization wich may lead to increased pain intensity and lower pain threshold sometimes to the extend of hyperalgesia and allodynia. Furthermore, patients with daily use of opioids may develop opioid tolerance, and to a lesser extent opioid induced hyperalgesia.

These factors may lead to a higher pain intensity in the perioperative setting resulting in the observed increased opioid dosage needed to treat the acute pain. Furthermore opioid titration may be difficult with higher levels of pain and a higher risk of opioid related adverse effects incl. respiratory depression and sedation.

The factors above advocate for utilizing opioid sparing analgesic techniques. In our department as in many others we use an multimodal opioid sparing approach for surgical procedures including epidural anesthesia (EA) as a standard part of the perioperative analgesia strategy after upper laparotomy, as a sufficient epidural anesthesia has shown to provide a stable and often better pain relief than systemic opioids in these patients.

Clinically, there is a suspicion that patients with CPS on fixed opioid treatment have a higher frequency of need for epidural optimization, despite the lack of an anatomical reason for this. One potential explanation could be an altered nociception, requesting another EA strategy than in non-opioid patients.

Purpose and hypothesis This study will explore the frequency of failed EA, defined as EA with insufficient analgesic effect to the extent were replacements of the epidural is needed within the first 5 postoperative days (PODs), testing the hypothesis that failed epidural occurs more frequent in patients with CPS on fixed opioid treatment than in non-opioid patients without CPS.

Detailed Description

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Conditions

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Chronic Pain Postoperative Pain Central Sensitisation

Study Design

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Observational Model Type

CASE_CONTROL

Study Time Perspective

RETROSPECTIVE

Study Groups

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Chronic pain

Patients with chronic pain and fixed opioid use, undergoing laparotomy with epidural anesthesia as a part of the postoperative analgesic strategy

Epidural replacement

Intervention Type PROCEDURE

Insufficient analgesic effect of epidural anesthesia to the extent were replacement of the catheter is needed.

Defined as insertion of a new epidural catheter

No chronic pain

Patients without chronic pain and without fixed opioid use, undergoing laparotomy with epidural anesthesia as a part of the postoperative analgesic strategy

Epidural replacement

Intervention Type PROCEDURE

Insufficient analgesic effect of epidural anesthesia to the extent were replacement of the catheter is needed.

Defined as insertion of a new epidural catheter

Interventions

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Epidural replacement

Insufficient analgesic effect of epidural anesthesia to the extent were replacement of the catheter is needed.

Defined as insertion of a new epidural catheter

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Patients undergoing elective laparotomy with epidural anesthesia as a part of the postoperative pain treatment
* For the intervention group - Patients with chronic pain disorder defined as pain for more than 3 months and a daily use of opioids regardless of dosage.
* For the control group - No chronic pain disorder defined as no daily use of opioid or other medicine with strong analgetic effect. A daily use of Acetaminophen and NSAIDs were deemed acceptable.

Exclusion Criteria

* Patients with substance abuse
* Suspected withdrawal due to opioid deficiency - noted in the medical chart
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Eske Kvanner Aasvang

OTHER

Sponsor Role lead

Responsible Party

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Eske Kvanner Aasvang

Professor, MD, DMSci

Responsibility Role SPONSOR_INVESTIGATOR

Locations

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Eske Kvanner Aasvang [eaasvang]

Copenhagen, , Denmark

Site Status

Countries

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Denmark

Other Identifiers

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WZ22042433

Identifier Type: -

Identifier Source: org_study_id

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