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Transversus Abdominis Plane Block in Microsurgical Breast Recon w/Abdominal Free Flap in Breast CA

A Phase III Study of Pre-operative Transversus Abdominis Plane Blocks Using the Nimbus Ambulatory Infusion System in Patients Undergoing Abdominal Free Flap-based Breast Reconstruction

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT02601027
Enrollment
120
Registered
2015-11-10
Start date
2015-11-30
Completion date
2021-06-30
Last updated
2021-09-23

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Breast - Female

Brief summary

The primary objective is to determine if pre-operative transversus abdominis plane (TAP) nerve blocks by continued infusion of local anesthetic post-operatively affects post-operative narcotic usage, as compared to a placebo TAP block, after breast reconstruction surgery.

Detailed description

Primary Objective: The primary objective is to determine if pre-operative transversus abdominis plane (TAP) blocks with continued infusion of local anesthetic post-operatively affect post-operative narcotic usage as compared to a placebo TAP block. Secondary Objectives: * Determine if pre-operative TAP blocks with continued infusion of local anesthetic post-operatively affect post-operative pain scores as compared to a placebo TAP block. * Determine if pre-operative TAP blocks with continued infusion of local anesthetic post-operatively affect anti-emetic usage as compared to a placebo TAP block. * Determine if pre-operative TAP blocks with continued infusion of local anesthetic post-operatively affect time to ambulation post-operatively as compared to a placebo TAP block. * Determine if pre-operative TAP blocks with continued infusion of local anesthetic post-operatively affect time to first bowel movement as compared to a placebo TAP block. * Determine if pre-operative TAP blocks with continued infusion of local anesthetic post-operatively affect patient-reported quality of life as compared to a placebo TAP block.

Interventions

PROCEDURETransversus Abdominis Plane (TAP) block
DEVICENimbus Infusion Pump IV Administration
DRUGHydromorphone
DRUGOxycodone
DRUGOndansetron

Sponsors

Stanford University
Lead SponsorOTHER

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
DOUBLE (Subject, Investigator)

Eligibility

Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

* Prior diagnosis or presumed diagnosis of breast cancer or undergoing prophylactic treatment. * Greater than 18 years old. * Female. * Undergoing microsurgical breast reconstruction with abdominal free flap. * Ability to understand and the willingness to sign a written informed consent document.

Exclusion criteria

* True allergy to local anesthetics or opioids. * History of addiction to narcotics within the last 24 months * History of chronic pain on opioids within the last 24 months. * Specific mental health issues such as schizophrenia or bipolar disorder. * Patients who are pregnant.

Design outcomes

Primary

MeasureTime frameDescription
Post-operative Narcotic Usage48 hoursNarcotic usage was collected for first 48 hours post-operatively after breast reconstruction. The type and amount of each narcotic administered were each converted to the morphine equivalent amount that would be orally administered to achieve the same event. This term is known as the oral morphine equivalent (OME). Narcotic usage was assessed between the group receiving transversus abdominis plane (TAP) nerve block compared to the group receiving the placebo control. The outcome is reported as the observed OME for each group.

Secondary

MeasureTime frameDescription
Post-operative Pain Score2 daysPost-operative Pain Score is defined using Visual Analog Scale (VAS), a patient-reported pain score based on viewing a graphic of a scale 0 to 10, and indicating pain level. Each participant was asked about 48 hours after breast reconstruction to indicate their their perceived pain according on the VAS scale. Higher scores represent greater pain. The outcome is reported as the mean VAS score at 48 hours, with standard deviation.
Post-operative Anti-emetic Usage48 hoursOdansetron by intravenous administration was used to control nausea (ie, an anti-emetic drug). Anti-emetic usage was collected for first 48 hours post-operatively after breast reconstruction for the group receiving transversus abdominis plane (TAP) nerve block compared to the group receiving the placebo control. The outcome is reported as the mean quantity of Odansetron in milligrams (mg) administered to each group, with standard deviation.
Time to Ambulationup to 1 weekTime to ambulation is defined as the amount of time, from midnight on post-operative Day 1 (ie, first midnight following the surgery), to when the participant to be able to stand up and walk a few steps post-operatively. The assessment of whether or not the participant was able to walk was subjective on the part of the shift nurse (ie, no defined number of steps nor quantitative assessment of gait or stability), and was not explicitly defined in the protocol or elsewhere. The outcome is reported as the time to ambulation in days, with standard deviation, for the group receiving transversus abdominis plane (TAP) nerve block and the group receiving the placebo control.
Time to First Bowel Movementup to 1 weekTime to first bowel movement is defined as the amount of time, from midnight on post-operative Day 1 (ie, first midnight following the surgery), to when the participant was to be able to pass a stool post-operatively. The outcome is reported as the time in days, with standard deviation, for the group receiving transversus abdominis plane (TAP) nerve block and the group receiving the placebo control.
Quality of Life MeasurementPre-operative Baseline and Post-operative (2-6 months)Quality of life for the study groups was assessed with the BREAST-Q questionnaire, a survey set of 6 pre-operative questionnaires comprised of 58 questions, and 15 post-operative questionnaires, collected 2 to 6 months after surgery, which is comprised of 109 questions. The results range for the pre-operative and post-operative questionnaire sets is 0 to 269 and 0 to 462, respectively. Because the baseline and post-operative domains are different, the BREAST-Q survey is not a measure of quality of life change over time. The Breast Q questionnaire was validated by Pusic, et al (citation provided). Higher scores for a domain represents better quality of life. The outcome is reported as the mean for each group and timepoint, with standard deviation.

Countries

United States

Participant flow

Participants by arm

ArmCount
0.125% Bupivacaine
0.125% bupivacaine infusion via transversus abdominis plane (TAP) catheter Transversus Abdominis Plane (TAP) block Nimbus Infusion Pump IV Administration Bupivacaine infusion Acetominophen Hydromorphone Oxycodone Ondansetron
64
Placebo
Saline infusion (sham) via transversus abdominis plane (TAP) catheter. Transversus Abdominis Plane (TAP) block Nimbus Infusion Pump IV Administration Acetominophen Hydromorphone Oxycodone Ondansetron
56
Total120

Withdrawals & dropouts

PeriodReasonFG000FG001
Registration to SurgeryWithdrawal by Subject2010

Baseline characteristics

CharacteristicPlaceboTotal0.125% Bupivacaine
Age, Categorical
<=18 years
0 Participants0 Participants0 Participants
Age, Categorical
>=65 years
7 Participants13 Participants6 Participants
Age, Categorical
Between 18 and 65 years
49 Participants107 Participants58 Participants
Age, Continuous52.11 years
STANDARD_DEVIATION 10.5
51.11 years
STANDARD_DEVIATION 9.98
50.24 years
STANDARD_DEVIATION 9.58
Race (NIH/OMB)
American Indian or Alaska Native
1 Participants1 Participants0 Participants
Race (NIH/OMB)
Asian
8 Participants16 Participants8 Participants
Race (NIH/OMB)
Black or African American
2 Participants5 Participants3 Participants
Race (NIH/OMB)
More than one race
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants1 Participants1 Participants
Race (NIH/OMB)
Unknown or Not Reported
7 Participants15 Participants8 Participants
Race (NIH/OMB)
White
38 Participants82 Participants44 Participants
Region of Enrollment
United States
56 participants120 participants64 participants
Sex: Female, Male
Female
56 Participants120 Participants64 Participants
Sex: Female, Male
Male
0 Participants0 Participants0 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
0 / 640 / 56
other
Total, other adverse events
21 / 6427 / 56
serious
Total, serious adverse events
0 / 640 / 56

Outcome results

Primary

Post-operative Narcotic Usage

Narcotic usage was collected for first 48 hours post-operatively after breast reconstruction. The type and amount of each narcotic administered were each converted to the morphine equivalent amount that would be orally administered to achieve the same event. This term is known as the oral morphine equivalent (OME). Narcotic usage was assessed between the group receiving transversus abdominis plane (TAP) nerve block compared to the group receiving the placebo control. The outcome is reported as the observed OME for each group.

Time frame: 48 hours

ArmMeasureValue (MEAN)Dispersion
0.125% BupivacainePost-operative Narcotic Usage139.3 milligrams (mg)Standard Deviation 117.2
PlaceboPost-operative Narcotic Usage169.2 milligrams (mg)Standard Deviation 136.5
Secondary

Post-operative Anti-emetic Usage

Odansetron by intravenous administration was used to control nausea (ie, an anti-emetic drug). Anti-emetic usage was collected for first 48 hours post-operatively after breast reconstruction for the group receiving transversus abdominis plane (TAP) nerve block compared to the group receiving the placebo control. The outcome is reported as the mean quantity of Odansetron in milligrams (mg) administered to each group, with standard deviation.

Time frame: 48 hours

ArmMeasureValue (MEAN)Dispersion
0.125% BupivacainePost-operative Anti-emetic Usage5.14 milligrams (mg)Standard Deviation 5.3
PlaceboPost-operative Anti-emetic Usage9.93 milligrams (mg)Standard Deviation 13.74
Secondary

Post-operative Pain Score

Post-operative Pain Score is defined using Visual Analog Scale (VAS), a patient-reported pain score based on viewing a graphic of a scale 0 to 10, and indicating pain level. Each participant was asked about 48 hours after breast reconstruction to indicate their their perceived pain according on the VAS scale. Higher scores represent greater pain. The outcome is reported as the mean VAS score at 48 hours, with standard deviation.

Time frame: 2 days

ArmMeasureValue (MEAN)Dispersion
0.125% BupivacainePost-operative Pain Score3.76 units on a scaleStandard Deviation 1.72
PlaceboPost-operative Pain Score3.96 units on a scaleStandard Deviation 2.14
Secondary

Quality of Life Measurement

Quality of life for the study groups was assessed with the BREAST-Q questionnaire, a survey set of 6 pre-operative questionnaires comprised of 58 questions, and 15 post-operative questionnaires, collected 2 to 6 months after surgery, which is comprised of 109 questions. The results range for the pre-operative and post-operative questionnaire sets is 0 to 269 and 0 to 462, respectively. Because the baseline and post-operative domains are different, the BREAST-Q survey is not a measure of quality of life change over time. The Breast Q questionnaire was validated by Pusic, et al (citation provided). Higher scores for a domain represents better quality of life. The outcome is reported as the mean for each group and timepoint, with standard deviation.

Time frame: Pre-operative Baseline and Post-operative (2-6 months)

Population: Most participants were lost to follow-up, and did not return the case report form (CRF) for this patient-reported Quality of Life (QoL) data

ArmMeasureGroupValue (MEAN)Dispersion
0.125% BupivacaineQuality of Life MeasurementPost-operative (2 to 6 month)342.11 score on a scaleStandard Deviation 26.42
0.125% BupivacaineQuality of Life MeasurementPre-operative baseline97.30 score on a scaleStandard Deviation 17.61
PlaceboQuality of Life MeasurementPre-operative baseline99.08 score on a scaleStandard Deviation 20.73
PlaceboQuality of Life MeasurementPost-operative (2 to 6 month)358.00 score on a scaleStandard Deviation 16.83
Secondary

Time to Ambulation

Time to ambulation is defined as the amount of time, from midnight on post-operative Day 1 (ie, first midnight following the surgery), to when the participant to be able to stand up and walk a few steps post-operatively. The assessment of whether or not the participant was able to walk was subjective on the part of the shift nurse (ie, no defined number of steps nor quantitative assessment of gait or stability), and was not explicitly defined in the protocol or elsewhere. The outcome is reported as the time to ambulation in days, with standard deviation, for the group receiving transversus abdominis plane (TAP) nerve block and the group receiving the placebo control.

Time frame: up to 1 week

ArmMeasureValue (MEAN)Dispersion
0.125% BupivacaineTime to Ambulation1.28 daysStandard Deviation 0.52
PlaceboTime to Ambulation1.45 daysStandard Deviation 0.62
Secondary

Time to First Bowel Movement

Time to first bowel movement is defined as the amount of time, from midnight on post-operative Day 1 (ie, first midnight following the surgery), to when the participant was to be able to pass a stool post-operatively. The outcome is reported as the time in days, with standard deviation, for the group receiving transversus abdominis plane (TAP) nerve block and the group receiving the placebo control.

Time frame: up to 1 week

ArmMeasureValue (MEAN)Dispersion
0.125% BupivacaineTime to First Bowel Movement1.67 daysStandard Deviation 1.08
PlaceboTime to First Bowel Movement1.62 daysStandard Deviation 0.99

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026