None listed
Conditions
Brief summary
This study will compare two commonly used methods of providing pain relief after robotic gynaecological surgery: a TAP block performed by the surgeon during the operation and a TAP block performed by the anaesthetist using ultrasound guidance. Participants will be randomly assigned to receive one of the two techniques. The main aim is to determine whether the surgeon-performed TAP block provides similar pain relief, measured by the amount of opioid pain medication required in the first 24 hours after surgery. We will also compare pain scores, nausea and vomiting, length of hospital stay, complications, and the time taken to perform each technique. The results may help identify the most effective and efficient approach to pain management for patients undergoing robotic gynaecological surgery.
Interventions
Participants randomised to the laparoscopic-guided TAP block arm will receive a bilateral transversus abdominis plane (TAP) block performed by the operating gynaecological surgeon under direct laparoscopic visualisation during robotic surgery for a benign gynaecological indication. During the robotic procedure and prior to skin closure, a standardised lateral TAP block technique will be used. Under laparoscopic visualisation, a regional anaesthesia needle will be inserted percutaneously at the m
Participants randomised to the laparoscopic-guided TAP block arm will receive a bilateral transversus abdominis plane (TAP) block performed by the operating gynaecological surgeon under direct laparoscopic visualisation during robotic surgery for a benign gynaecological indication. During the robotic procedure and prior to skin closure, a standardised lateral TAP block technique will be used. Under laparoscopic visualisation, a regional anaesthesia needle will be inserted percutaneously at the mid-axillary line between the costal margin and iliac crest. The needle tip will be advanced into the fascial plane between the internal oblique and transversus abdominis muscles. Correct placement will be confirmed by laparoscopic visualisation of tissue-plane hydrodissection following injection of a small test volume. Following negative aspiration, 20 mL of ropivacaine 0.2% will be injected incrementally into the transversus abdominis plane on each side (40 mL total). The TAP block is expected to add approximately 5–10 minutes to the operative procedure. Intervention fidelity and adherence will be assessed through review of operative records, anaesthetic records, medication administration records and REDCap intraoperative case report forms, which will document completion of the allocated TAP block, timing relative to surgery, proceduralist, local anaesthetic agent, dose and volume administered, procedure duration, and any protocol deviations.
Sponsors
Dr Harry Baxter, Gynaecology Fellow
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
To be eligible to enter the study all patients must satisfy the following criteria: 1. Adult aged 18 years and over; 2. Undergoing gynaecological surgery for a non-cancer indication at Royal Prince Alfred Hospital (RPAH); 3. Clinically suitable for robotic procedures; 4. Cognitively able to give written informed consent for participation; 5. Elective procedure.
Exclusion criteria
Patients will be excluded if they present the following exclusion criteria: 1. The patient lacks the ability to consent for themselves; 2. Patients unwilling to complete pre- and post-operative assessment; 3. Patient factors precluding robotic surgery. 4. Chronic opioid use (defined as daily use) 5. Allergy to local anaesthetics 6. Epidural or spinal anaesthesia planned
Outcome results
None listed