A Comparison of Exparel to Bupivacaine in TAP Block for Abdominal Gynecologic Surgery

Abington Memorial Hospital128 enrolled

Overview

This study evaluates the comparison between liposomal bupivacaine versus bupivacaine HCl in Transversus Abdominis Plane blocks for gynecologic surgery on the length of stay in the hospital, total narcotic use, and overall complications rates.

The proposed pilot study is evaluating the use of Exparel ™ in an anesthesia protocol for patients undergoing major lower abdominal gynecologic surgery. Exparel ™ is a formulation of liposomal bupivicaine that is reputed to have a much longer duration of action compares to bupivacaine. Exparel™ has been originally demonstrated to be safe and effective in bunionectomy and hemorrhoidectomy. It has recently gained FDA approval for all surgical site infiltration including TAP (Transversus Abdominis Planus block) blocks. Exparel™ has also been studied in other procedures and demonstrated reduction in opioid use and median length of stay (LOS). Currently, patients on the gynecologic oncology service undergoing major abdominal surgery are receiving a type of regional anesthesia using bupivacaine HCl known as a TAP block as part of an effort to decrease narcotic use post-operatively and decrease hospital length of stay. Bupivacaine has a known eight to twelve hour duration of action, thus addressing immediate post operative pain. As Exparel™ is anticipated to have a longer duration of action, the purpose of this study is to determine if TAP blocks with Exparel™ have an advantage over standard TAP blocks with bupivacaine HCl in reducing length of hospital stay in a randomized controlled trial. Our hypothesis is that TAP blocks with Exparel™ will result in reduced length of stay contributing to significant hospital cost savings. Secondary outcomes include total narcotic use (hypothesized to be reduced) and overall complication rates (hypothesized to remain unchanged). Given there are no published data on the efficacy and safety of using Exparel™ in open gynecologic abdominal surgery, this will be a pilot study.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

TRIPLE

Enrollment

128

Conditions

Gynecologic Cancer Post Operative Pain

Interventions

BupivacaineDRUG

bupivacaine hydrochloride used in TAP block

liposomal bupivacaineDRUG

liposomal bupivacaine used in TAP block

Eligibility

Sex: FEMALEMin age: 18 YearsMax age: 99 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * all patients undergoing planned exploratory laparotomy * TAP blocks placed after the laparotomy incision is closed, but before the patient is awake, and placed under ultrasound guidance with correct identification of the correct abdominal plane. * Consent for TAP block signed by patients preoperatively by anesthesiology Exclusion Criteria: * All pregnant patients * All patients under 18 years of age * minimally invasive surgery such as laparoscopy or robotic assisted laparoscopy * medical contraindications to use of bupivacaine or liposomal bupivacaine such as severe hepatic and/or renal disease

Locations (1)

Abington Hospital Jefferson Health

Abington, Pennsylvania, United States

RECRUITING

Outcomes

Primary Outcomes

Length of stay post operatively in hospital

number of hours patient stays post operatively in hospital

Time frame: through study completion, expected to be approximately 1 year in total

Secondary Outcomes

total opioid use post operatively in hospital

total opioid use in morphine equivalent that patient uses

Time frame: through study completion, expected to be approximately 1 year in total

Central Contacts

Heidi Ching, MD

CONTACT

215-481-4231 heidi.ching@jefferson.edu

Mark Shahin, MD

CONTACT

215-885-0220 mark.shahin@jefferson.edu

Data from ClinicalTrials.gov

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