TAP Block: Does Volume Make a Difference?

McMaster University31 enrolled

Overview

Patients who have abdominal surgery will experience pain from the incision. The lumbar TAP block is a procedure used to reach the nerve endings in the abdominal wall so that there is a reduction in pain after surgery. Using ultrasound guidance, a solution of ropivacaine will be injected after surgery. The aim of this study is to determine the effect of changes in the volume of the injection.

Pain from a surgical incision happens in most patients. During the perioperative period, the use of the TAP block has been shown to reduce pain scores, opioid consumption and sedation scores. Also, there is a trend towards a reduction of post-operative nausea and vomiting. The aim of the block is to reach the distal nerve endings of the abdominal wall from T6 to L1 dermatomes using ultrasound guidance with a single shot of ropivacaine at different volumes. Currently, there is consensus about optimal procedure-specific volumes and local anesthetic concentrations for lumbar TAP blocks. This is a pilot study and the purpose being is it feasible to do a large scale clinical study to determine the influence of increasing the local anesthetic volume.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

TRIPLE

Enrollment

Conditions

Post-operative Pain

Interventions

RopivacaineDRUG

20mLs of 0.5%

RopivacaineDRUG

30mLs of 0.33%

RopivacaineDRUG

40mLs of 0.25%

Eligibility

Sex: FEMALEMin age: 18 YearsMax age: 70 Years

Medical Language ↔ Plain English

Inclusion Criteria: * 18-70 years old * total abdominal hysterectomy * capable of completing informed consent * no previous chronic opioid use * no previous abdominal wall surgeries Exclusion Criteria: * patient refusal * contraindication to regional anesthesia: coagulopathy, anticoagulant use, bleeding disorders, * local or systemic infection * local anesthetic allergy * BMI\>35

Locations (1)

St. Joseph's Healthcare Hamilton

Hamilton, Ontario, Canada

Outcomes

Primary Outcomes

To assess the feasibility of a large scale clinical study to determine the influence on increasing the local anesthetic volume.

This will be shown as a number and a percenttage of patients recruited and randomized.

Time frame: 6 month

Secondary Outcomes

Using ice and pinprick, determine the dermatomal block distribution at 2,6,12,24 and 48 hours post block.

The assessor will measure the extend of the block distribution at the various time intervals.

Time frame: 48 hours

Pain scores at 2,6,12,24, and 48 hours post-block.

Using a visual analog scale, patient pain scores will be assessed.

Time frame: 48 hours

Patient-controlled analgesia opioid requirements at 2,6,12,24 and 48 post-block.

Record drug consumption at the time intervals

Time frame: 48 hours

Incidence of post-operative nausea and vomiting at 2,6,12,24, and 48 hours.

Time frame: 48 hours

Block failure rate.

Block failure rate is defined as the lack of any sensory block following the TAP block.

Time frame: 48 hours

Patient's overall satisfaction.

Using a LIKERT score, patient satisfaction will be measured.

Time frame: 48 hours

Discharge time from PACU.

The time in which the patient is discharged from the recovery room.

Data from ClinicalTrials.gov

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