HERALD-1: HEpatic Resection Analgesia and Length of time to Discharge

• Research type

  Research Study

• Full title

  Short-term Outcomes with Intrathecal Opioid and Patient Controlled Analgesia versus Thoracic Epidural Analgesia for Hepatic Resection: A Randomised Controlled Trial

• IRAS ID

  129050

• Contact name

  Susan Mallett

• Contact email

  susan.mallett@nhs.net

• Sponsor organisation

  University College London

• Research summary

  Hepatic resection is an operation where the part of the liver containing cancer is removed. Pain relief plays an important part in the patient’s recovery following this type of surgery, with the potential to improve patient outcomes.

  Traditionally epidural pain relief (infusing local anaesthesia and painkillers for up to three days through a tube inserted in the upper back (thoracic region)) has been used. Epidurals offer excellent pain relief, however, they can stop working effectively, and their side effects have been associated with a slower recovery from surgery. In other types of surgery (such as bowel surgery) using alternative forms of pain relief to epidural can improve recovery, without compromising pain relief. One option is spinal (intrathecal) injections (a single injection of local anaesthetic and painkiller around the nerves which lasts for up to 48 hours). This form of pain relief has been reported as an alternative to epidural pain relief for liver resection but there is no research evidence as to whether it is better for this operation.
  
  This randomised controlled trial at the Royal Free Hospital, randomly allocating patients undergoing hepatic resection to receive either spinal (and intravenous) or epidural pain relief. The primary outcome is the length time until patients are medically fit for discharge. The trial will last for 12 months and is funded by the National Institute for Academic Anaesthesia and Royal Free Charity.

  This study will provide high quality evidence as to whether the choice of pain relief affects the length of time that patients take to recover from hepatic resection surgery. Showing the use of either spinal or epidural analgesia to be associated with better outcomes including time until medically fit for discharge will ensure that the most effective form of analgesia is used for this surgery.

• REC name

  London - Harrow Research Ethics Committee

• REC reference

  14/LO/1174

• Date of REC Opinion

  7 Oct 2014

• REC opinion

  Further Information Favourable Opinion