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NCT07351994

Autonomic Neural Field Block for Visceral Pain in Minimally Invasive Left-Sided Colectomy

Sponsor: Antonio Caycedo, MD

View on ClinicalTrials.gov

Summary

Effective postoperative pain control is a core component of enhanced recovery after surgery (ERAS) pathways in colorectal surgery; however, postoperative pain following minimally invasive left-sided colectomy remains a persistent clinical challenge. Standard multimodal analgesic strategies primarily target somatic pain pathways and may inadequately address visceral postoperative pain, which is mediated through autonomic afferent neural pathways. Residual visceral pain is associated with increased opioid consumption, postoperative nausea and vomiting, delayed recovery, and prolonged length of stay. This prospective, multicenter observational registry evaluates the feasibility and real-world outcomes of an intraoperative autonomic neural field block targeting the superior hypogastric and inferior mesenteric plexuses during minimally invasive left-sided colectomy. The technique is performed under direct visualization as an adjunct to standard ERAS-based analgesic care. The primary outcome is postoperative opioid consumption within the first 24 hours after surgery. Secondary outcomes include opioid use through 48 hours, postoperative nausea and vomiting, antiemetic use, pain scores, length of stay, and readiness for discharge. Data from this registry will inform future comparative studies and help define the role of autonomic neural modulation in perioperative pain management for colorectal surgery.

Official title: Autonomic Neural Field Block for Visceral Pain Control in Minimally Invasive Left-Sided Colorectal Resections

Key Details

Gender

All

Age Range

18 Years - Any

Study Type

OBSERVATIONAL

Enrollment

400

Start Date

2026-01-20

Completion Date

2026-09-01

Last Updated

2026-01-20

Healthy Volunteers

Yes

Conditions

Postoperative Pain Postoperative Nausea Opioid Use

Interventions

PROCEDURE

Autonomic Neural Field Block

An intraoperative autonomic neural field block targeting the superior hypogastric and inferior mesenteric plexuses is performed under direct visualization during elective minimally invasive left-sided colorectal resection. The block is administered using incremental injections of diluted local anesthetic as an adjunct to standard perioperative analgesic care within established enhanced recovery after surgery (ERAS) pathways.

Inclusion Criteria: * Age ≥ 18 years. * Scheduled for elective minimally invasive (laparoscopic or robotic) left-sided colonic or rectal resection with primary anastomosis constructed above the peritoneal reflection (e.g., sigmoid colectomy, left colectomy, anterior resection/rectosigmoid resection with intraperitoneal anastomosis). * Planned intraoperative administration of autonomic neural field block targeting the superior hypogastric plexus and/or inferior mesenteric plexus, performed under direct visualization, as part of routine operative workflow. * Managed perioperatively under an institutional standard analgesic pathway (e.g., ERAS or equivalent), with postoperative opioid administration recorded in the medical record. * Ability to provide informed consent Exclusion Criteria: * Emergency/urgent colorectal surgery (e.g., perforation, uncontrolled bleeding, toxic megacolon, obstructing cancer requiring urgent operation). * Planned open left-sided colectomy/rectal resection (minimally invasive approach not intended). * Procedures in which no primary anastomosis is created (e.g., Hartmann's procedure, end colostomy, permanent diversion without anastomosis). * Planned low pelvic/extra-peritoneal anastomosis (e.g., low anterior resection with anastomosis at or below the peritoneal reflection) or planned handsewn coloanal anastomosis. * Known allergy or contraindication to the local anesthetic agents used for the block (or inability to receive local anesthetic for clinical reasons). * Inability to reliably capture outcome data for the primary endpoint (e.g., anticipated transfer to another facility within 24 hours post-op, incomplete medication administration records). * Pregnancy * Prisoners or other protected populations where participation is restricted * Chronic opioid therapy at baseline defined as daily opioid use for \> 30 days preoperatively, or baseline opioid dose \> 30 MME/day * Planned use of neuraxial analgesia (epidural/spinal) intended for postoperative analgesia