Secondary Logo

Institutional members access full text with Ovid®

Share this article on:

Medial Open Transversus Abdominis Plane (MOTAP) Catheters Reduce Opioid Requirements and Improve Pain Control Following Open Liver Resection: A Multicenter, Blinded, Randomized Controlled Trial

Karanicolas, Paul Jack, MD, PhD*,§; Cleary, Sean, MD, MSc, MPH†,**; McHardy, Paul, MD; Kiss, Alex, PhD§; Sawyer, Jason, NP; Behman, Ramy, MD*; Ladak, Salima, NP, PhD; McCluskey, Stuart A., MD, PhD||; Srinivas, Coimbatore, MD||; Katz, Joel, PhD¶,||; Coburn, Natalie, MD, MPH*,§; Law, Calvin, MD, MPH*,§; Wei, Alice C., MD, MSc; Greig, Paul, MD; Hallet, Julie, MD, MSc*; Clarke, Hance, MD, PhD¶,||

doi: 10.1097/SLA.0000000000002657

Objective: Conventional management of pain following open liver resection involves intravenous, patient-controlled analgesia (IV PCA) or epidural analgesia. The objective of this trial was to assess the efficacy of a regional technique called Medial Open Transversus Abdominis Plane (MOTAP) catheter analgesia compared with IV PCA.

Methods: This was a blinded, randomized, controlled parallel-arm trial conducted at 2 high-volume centers. Patients undergoing liver resection through a subcostal incision were enrolled. Using a standardized technique, 2 catheters were placed after resection: one in the plane between internal oblique and transversus abdominis and the other in the posterior rectus sheath. Patients were randomized to receive ropivacaine 0.2% (ROP) or saline (NS) through both catheters for 72 hours. All patients received IV PCA with hydromorphone as part of a multimodality analgesia program. Primary outcome was opioid use over the first 48 hours.

Results: One hundred fifty-three patients were included in the analysis (71 ROP, 82 NS). Patients receiving ROP used significantly less opioid than patients with NS at 48 hours (median 39.6 mg morphine-equivalent vs 49.2 mg, P = 0.033) and at 72 hours (median 50.0 vs 66.4 mg, P = 0.046). Pain scores at rest and with coughing were significantly lower at all time points in patients who received ROP (P = 0.002). Median length of hospital stay was 5 days in patients receiving ROP and 6 days in patients who received NS (P = 0.035). There was no difference between groups in complications [ROP 20 (28.2%) vs NS 26 (31.7%), P = 0.63].

Conclusion: MOTAP catheter analgesia reduces opioid requirements, pain, and length of hospital stay compared with IV PCA following open liver resection with subcostal incisions.

*Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario

Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario

Department of Anaesthesia, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario

§Department of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario

Department of Anaesthesia and Pain Management, University Health Network, University of Toronto, Toronto, Ontario

||Pain Research Unit, Toronto General Hospital, University Health Network, Toronto, Ontario

**Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, NY.

Reprints: Paul Jack Karanicolas, MD, PhD, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, T2-016, Toronto, ON M4N3M5. E-mail:

This research was supported by the Innovation Fund of the Alternative Funding Plan from the Academic Health Sciences Centres of Ontario. Dr. Karanicolas is supported by a Canadian Institute of Health Research (CIHR) New Investigator Award. Dr. Clarke is supported by a University of Toronto, Department of Anesthesia Research Merit Award.

The study is registered with (NCT01960049, September 23, 2013).

The authors declare no conflict of interests.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.