Acute Pain, Regional Anesthesia, Surgery
Conditions
Brief summary
This study will compare the infiltrative transversusabdominis plane (TAP) block with liposomal bupivacaine to epidural analgesia (EA) in major abdominal surgery . The efficacy of the TAP block for abdominal surgery is well documented in literature, but there are no studies utilizing long-acting bupivacaine. The investigators believe the study will demonstrate no difference between the two in terms of pain scores and opioid consumption, but TAP blocks will decreased costs, urinary retention, and hypotension.
Detailed description
This study intends to examine this rational by comparing the infiltrative transversusabdominis plane (TAP) block with liposomal bupivacaine to EA in major abdominal surgery. The efficacy of the TAP block for abdominal surgery is well documented in the literature, but there are no studies utilizing long-acting bupivacaine. The investigators believe the primary outcome will demonstrate no difference between the two in terms of pain scores and opioid consumption. The investigators anticipate that patients who have undergone TAP blocks will have improved secondary outcomes with respect to a decreased costs, urinary retention, and hypotension.
Interventions
DRUGEpidural
The skin will be disinfected with 2% chlorhexidine. Under sterile technique, the epidural will be placed. Epidural catheter will be placed at thoracic vertebral levels T5 to T10. Level chosen as clinically indicated. The epidural solution should contain institution's standard solution of Bupivicaine 0.05% and hydromorphone 10 mcg/cc. However, solution type should be clinically indicated.
DRUGTAP Block
The skin will be disinfected with 2% chlorhexidine. The bilateral dual TAP infiltrative blocks will be placed using high-frequency ultrasound. The TAP blocks will be performed using lipospheric bupivacaine (Exparel) with the following dosing regimen.A 266mg (20cc) vial of lipospheric bupivacaine will be equally into 2 30 ml syringes using strict sterile technique. The solution will be diluted in each syringe with 20cc preservative free sterile 0.9% normal saline to a total volume of 30 ml in each syringe. Once the transversus abdominal plane is identified then a 5-10 ml of plain 0.9% normal saline will be injected to open the fascial plane. Once the plane is opened then the 15cc of diluted lipospheric bupivacaine will be administered under direct ultrasound visualization in all 4 TAP quadrants (subcostal position x2 and lateral position x2)
Sponsors
University of Nebraska
Study design
Observational model
OTHER
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
19 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* subject \>/= 19 years of age * Undergoing major abdominal surgery * able to provide written informed consent
Exclusion criteria
* chronic opioid use * allergies to amide anesthetics * inability to undergo general anesthesia * pregnancy * any existence of contraindications to regional anesthesia in the presence of antiplatelet or anticoagulative drugs * or evidence of gross neurological dysfunction of the lower extremity
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pain scores | 96 hours post-op | Comparison of pain scores (0 = no pain to 10 = worst pain possible) |
| Opioid Consumption in a 24-Hour period | 96 hours post-op | A comparison of opioid consumption in a 24-Hour period at 96 hours post-op between the interventions |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Comparison of 96-hour hospital stay costs | 96 hours post-op | Comparison of 96-hour hospital stay cost between the interventions |
| Comparison of urinary failure/catheter acquired infection rates | 96 hours post-op | Comparison of urinary failure/catheter acquired infection rates between the interventions |
| Comparison of hypotension rates | 96 hours post-op | Comparison hypotension rates between the interventions |
Countries
United States
Outcome results
None listed