Study of Recovery After Surgery for Colorectal Cancer Using Lidocaine and Ropivacaine in Patients Undergoing Laparoscopic Colorectal Cancer Surgery

Anesthesia and surgery preparation

Your scheduled surgery will be performed using a minimally invasive technique called laparoscopic surgery for colorectal cancer. This means small incisions will be made in your abdomen through which surgical instruments are inserted.

Before the surgery begins, you will receive anesthesia to ensure you are asleep and pain-free during the procedure. The anesthesia will include propofol administered through a vein as an injection or infusion, and ketamine given through a vein at a dose of 10 mg per milliliter.

During the operation, you will receive sufentanil at a dose of 5 micrograms per milliliter through a vein to manage pain.

Pain management during surgery

During the surgery, you will receive lidocaine administered through a vein. This medication helps reduce pain and improve recovery after surgery.

The surgical sites where the instruments are inserted will be treated with ropivacaine at a concentration of 2 mg per milliliter. This local anesthetic is injected into the tissue to provide pain relief at the incision sites.

You will also receive dexamethasone phosphate at a dose of 8 mg through a vein. This medication helps reduce inflammation and nausea after surgery.

Immediate post-surgery monitoring

After the surgery is completed, you will be moved to a recovery area where you will be monitored for up to two hours.

During this time, medical staff will observe you for any signs of medication-related side effects, including heart rhythm changes, tingling around the mouth, headaches, visual or hearing changes, tremors, or other neurological symptoms.

Blood samples will be taken to measure the levels of lidocaine and ropivacaine in your blood to ensure they remain within safe limits.

Pain assessment at two hours after surgery

At two hours after your surgery, your pain level will be assessed while you are resting. You will be asked to rate your pain on a scale from 0 to 10, where 0 means no pain and 10 means the worst pain imaginable.

Pain management in the first 48 hours

You will receive paracetamol through a vein at a dose of 10 mg per milliliter to help control pain.

You will also receive nefopam at a dose of 20 mg through a vein as needed for pain relief.

If additional pain relief is needed, you will receive parecoxib at a dose of 40 mg through a vein.

For oral pain management, you may receive celecoxib capsules at a dose of 100 mg.

If stronger pain relief is required, you will receive morphine sulfate capsules at a dose of 5 mg. The total amount of morphine-type medications you receive will be recorded and converted to a standard measurement for comparison.

Assessment at 24 hours after surgery

At 24 hours after your surgery, your overall recovery will be assessed using a questionnaire called the QOR-15. This questionnaire asks about your physical comfort, emotional state, and ability to perform daily activities.

Your pain level will be assessed again at rest and while moving. You will be asked to rate your pain on the same 0 to 10 scale.

Assessment at 48 hours after surgery

At 48 hours after your surgery, your pain level will be assessed once more, both at rest and while moving.

You will be asked about the maximum pain you experienced during the first 48 hours after surgery.

Medical staff will check for any unusual sensations around your surgical scars, such as increased sensitivity to pain, sensitivity to touch that normally would not be painful, or numbness.

You will be asked questions to determine if you are experiencing any nerve-related pain. This assessment uses a scoring system where a score greater than 4 out of 10 indicates nerve pain.

The medical team will ask you daily about your bowel function, including whether you have passed gas or had a bowel movement, and whether you are able to tolerate food.

Hospital discharge

The length of your hospital stay will be recorded from the day you are admitted until the day you are discharged.

Before you leave the hospital, you will be asked to complete a satisfaction questionnaire called the EVANS score to evaluate your experience.

Follow-up at one month after surgery

At one month after your surgery, any medical or surgical complications you may have experienced will be assessed using a classification system called the Clavien Dindo score. This system categorizes complications based on their severity.

Follow-up at two months after surgery

At two months after your surgery, the medical team will determine whether you are able to begin chemotherapy treatment if it has been recommended by your cancer care team.

Follow-up at three months after surgery

At three months after your surgery, you will be assessed again for nerve-related pain using the same scoring system as before. A score greater than 4 out of 10 indicates nerve pain.