The purpose of this study is to assess the effectiveness of transversus abdominal plane (TAP) block, thoracic epidural or paravertebral block (PVB) for controlling postoperative pain when compared with opioid you self-administer in your vein using a PCA device. The primary outcome will be postoperative opioid consumption within 24 hours after surgery. A total of 120 subjects will be randomized in a 1:1:1:1 ratio to receive a TAP block, PVB, TEA or no block (PCA alone).Patients in all groups will be cared for using an established enhanced recovery after surgery (ERAS) pathway incorporating a multimodal analgesic regimen using IV acetaminophen and postoperative PCA fentanyl.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
17
1.5% lidocaine
1:200,000 epinephrine
400-800 mcg Hydromorphone will be given preoperatively
Duke University Medical Center
Durham, North Carolina, United States
Postoperative Opioid Consumption
If opioid other than fentanyl is used, the dose will be converted to morphine equivalent.
Time frame: 24 hours after surgery
Pain Scores
Pain scores at rest and with activity using a verbal rating scales (VRS) of 0-10, where "0" represents no pain and "10" represents worst pain ever, at 30, 60, 90, 120 min and every 6 hours for 24 hours and every 12 hours for 48 hours and once a day thereafter until discharge. Data were collected at the indicated time points and an average pain score was calculated.
Time frame: Participants will be followed for the duration of hospital stay, an estimated 1 week
Quality of Recovery
Quality of Recovery Score (QoR-15) is measured on a scale of 0-150 (0=poor, 150 = excellent). Scores were collected daily for 72 hours and then averaged.
Time frame: 72 hours
Complications as Measured by a Modified Postoperative Morbidity Survey (MPMS)
Complications using a Modified Postoperative Morbidity Survey (MPMS)
Time frame: Participants will be followed for the duration of hospital stay, an estimated 1 week
Time to First Bowel Movement
Time frame: Participants will be followed for the duration of hospital stay, an estimated 1 week
Opioid Related Side Effects
Occurrence and duration of opioid related adverse events including postoperative nausea and vomiting (PONV); pruritus, urinary retention, confusion, sedation and respiratory depression at the above time points.
Time frame: Participants will be followed for the duration of hospital stay, an estimated 1 week
Time to First Ingestion of Solid Food
Time frame: Participants will be followed for the duration of hospital stay, an estimated 1 week
Number of Epidural-related Side Effects
Time frame: Participants will be followed for the duration of hospital stay, an estimated 1 week
Length of Stay
Time frame: Participants will be followed for the duration of hospital stay, an estimated 1 week
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