Transversus Abdominis Plane Block From Abdominal Approach
Conditions
Brief summary
Randomized double blind placebo controlled trial on transversus abdominus plane block approached from abdominal cavity, in patients undergoing total abdominal hysterectomy.
Detailed description
Potential advantages compared to percutaneous approach are decrease in risk of visceral injury as it is under direct visual and tactile guidance, ease of approach in obese patients, short theatre time for administration, easy to administer.
Interventions
PROCEDURETransversus abdominis plane block
This intraabdominal approach to TAP block is being used regularly by gynaecological surgeons in this hospital now. To be performed bilaterally before surgical wound closure by an experienced surgeon who initially undergo initial observation by investigator to ensure uniformity in technique. Local anaesthetic or placebo solution will be injected to TAP with blunt needle from within abdominal cavity under visual and tactile guidance at the triangle of Petit, after feeling one 'pop' through the transversus abdominis muscle to the TAP layer. After careful aspiration to exclude vascular puncture, 1.5mg/kg of 0.5% ropivacaine or 0.3ml/kg of 0.9% saline placebo will be injected to each side slowly while observing for signs of toxicity.
Sponsors
United Christian Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Outcomes Assessor)
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* ASA physical status I-III * Age 18 or above * Scheduled to undergo TAH+/- salpingoophorectomy. * Scheduled to receive general anaesthesia under standardized anaesthetic regime. * Comprehends how to use intravenous patient controlled analgesia (IV PCA). * Is willing to complete the postoperative assessment. * Understands the nature and purpose of this study and the study procedures and has signed the informed consent form for this study to indicate this understanding.
Exclusion criteria
* Known allergy to drugs involved in this study * Previously taking medications thought to result in opioid tolerance, or analgesics thought to interfere with subsequent opioid requirement. * Undergoing any procedures in addition to TAH+/- salpingoophorectomy. * With co-existing pathology resulting in persistent pain requiring analgesics. * Wound incision extending to supra-umbilical level.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| postoperative 24hr morphine consumption | 24 hours | The primary objective of this study is to demonstrate the effectiveness of tranversus abdominis plane block using the intraabdominal approach in reducing postoperative 24 hours morphine consumption after total abdominal hysterectomy (TAH) where time 0 is taken as time of arrival at PACU. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| morphine consumption on arrival to post-anaesthetic care unit(PACU) and 4, 12 and 24 hours after. | 24hrs | • Assess and compare the morphine consumption on arrival to post-anaesthetic care unit(PACU) and 4, 12 and 24 hours after. |
| Degree on pain according to numerical pain score on arrival to post-anaesthetic care unit(PACU) and 4, 12 and 24 hours after during rest and movement (cough | 24hrs | — |
| incidence of nausea and vomiting | 24hours postoperatively | — |
Countries
Hong Kong
Contacts
Primary ContactWing Yee Lillian Choy, MBBS (HK)
Outcome results
None listed