Study the effect of laparoscopic guided TAP block on opioid consumption and associated costs using a mixture of dexmedetomidine, dexamethasone, and ropivacaine versus Liposomal bupivacaine (Exparel®) in patients who undergo elective minimally invasive colorectal surgery.
This is a non-inferiority single-blinded randomized trial aiming to study the effect of laparoscopic guided TAP block on opioid consumption and associated costs using a mixture of dexmedetomidine, dexamethasone, and ropivacaine versus Liposomal bupivacaine (Exparel®) in patients who undergo elective minimally invasive colorectal surgery. This study aims to continue improving our current hospital wide effort in reducing opioid consumption and, consequently, the acute and long-term consequences of opioids. It will also complement the current ongoing efforts of the Department of Surgery's quality and safety improvement project in opioid stewardship. Additionally, this dual adjunct TAP solution combination is inexpensive ($28 per injection) and may result in a significant cost savings for the hospital.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
SINGLE
Ropivacaine 0.5% HCl, 40 mL (5 mg per mL) (200 mg) Dexmedetomidine HCl, 0.50 ml (100 ug per mL) (50 ug) Dexamethasone sodium phosphate, 1 mL (10 mg per mL) (10 mg) Normal saline 0.9%, 18.5mL
Liposomal bupivacaine, 20 mL (13.3 mg/ml) (266 mg) Normal saline 0.9%, 40mL
Post-operative opioid consumption in the first 72 hours
Total amount of both intravenous and oral opioid use in the first 72 hours after surgery measured in morphine milligram equivalents.
Time frame: 72 hours
Post-operative opioid consumption over hospital stay
Total morphine dose equivalents administered throughout hospital stay
Time frame: 2 months
Visual analog scale pain scores in the PACU
Visual analog scale (VAS) pain scores in the PACU
Time frame: 72 hours
Visual analog scale pain scores 12 hours post op
Visual analog scale pain scores 12 hours post op
Time frame: 12 hours
Visual analog scale pain scores 24 hours post op
Visual analog scale pain scores 24 hours post op
Time frame: 24 hours
Visual analog scale pain scores 36 hours post op
Visual analog scale pain scores 36 hours post op
Time frame: 36 hours
Visual analog scale pain scores 48 hours post op
Visual analog scale pain scores 48 hours post op
Time frame: 48 hours
Visual analog scale pain scores 72 hours post op
Visual analog scale pain scores 72 hours post op
Time frame: 72 hours
Epidural need
Need for an epidural post-operatively. Reviewed using the EMR.
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Time frame: 2 months
Need for postoperative patient-controlled analgesia (PCA)
Determined by review of EMR. Patients use or non-use of PCA.
Time frame: 72 hours
Need for adjunctive systemic nonopioid pain medications
Adjunctive systemic nonopioid pain medications
Time frame: 2 months
Prescribed opioid at discharge
Amount of opioid prescribed at discharge
Time frame: 2 months
Outpatient narcotic refill
Use the EMR to determine outpatient narcotic refill
Time frame: 2 months
Length of hospital stay
To assess the impact of laparoscopic guided TAP blocks and dual-adjunct therapy on length of hospital stay following minimally invasive (laparoscopic or robotic) surgery of the colon and rectum. Calculating the length of hospital stay will allow for evaluation of effectiveness of dual adjunct therapy in context of ERAS protocol compared to liposomal bupivacaine
Time frame: 2 months
Use of antiemetics in the first 12 hours post op
To assess the impact of laparoscopic guided TAP blocks and dual-adjunct therapy on return of bowel function following minimally invasive (laparoscopic or robotic) surgery of the colon and rectum. Antiemetic dosage reviewed using the EMR.
Time frame: 12 hours
Use of antiemetics in the first 24 hours post op
To assess the impact of laparoscopic guided TAP blocks and dual-adjunct therapy on return of bowel function following minimally invasive (laparoscopic or robotic) surgery of the colon and rectum. Antiemetic dosage reviewed using the EMR.
Time frame: 24 hours
Use of antiemetics in the first 36 hours post op
To assess the impact of laparoscopic guided TAP blocks and dual-adjunct therapy on return of bowel function following minimally invasive (laparoscopic or robotic) surgery of the colon and rectum. Antiemetic dosage reviewed using the EMR.
Time frame: 36 hours
Use of antiemetics in the first 48 hours post op
To assess the impact of laparoscopic guided TAP blocks and dual-adjunct therapy on return of bowel function following minimally invasive (laparoscopic or robotic) surgery of the colon and rectum. Antiemetic dosage reviewed using the EMR.
Time frame: 48 hours
Use of antiemetics in the first 72 hours post op
To assess the impact of laparoscopic guided TAP blocks and dual-adjunct therapy on return of bowel function following minimally invasive (laparoscopic or robotic) surgery of the colon and rectum. Antiemetic dosage reviewed using the EMR.
Time frame: 72 hours
Time to first flatus
Days from surgery to first flatus postoperatively. Reviewed using the EMR.
Time frame: 2 months
Time to first bowel movement
Days from surgery to first bowel movement postoperatively. Reviewed using the EMR.
Time frame: 2 months
Need to insert nasogastric tube
To assess the impact of laparoscopic guided TAP blocks and dual-adjunct therapy on return of bowel function following minimally invasive (laparoscopic or robotic) surgery of the colon and rectum. Reviewed using the EMR.
Time frame: 2 months