Laparoscopic Cholecystectomy
Conditions
Keywords
Pediatric, post-operative pain prevention, Anesthesia, Infiltration, Nerve Blockade
Brief summary
The objective of this study is to compare transversus abdominis plane (TAP) blocks to local wound infiltration (LWI) in terms of postoperative pain control in pediatric patients undergoing elective laparoscopic cholecystectomy. Our hypothesis is that TAP blocks will be superior to LWI for postoperative pain control resulting in decreased use of opioid / narcotic pain medication and decreased pain scored in the immediate 24-hour postoperative period. The rationale is that determining the effect of analgesia in this pediatric population is important to optimize clinical care.
Detailed description
In this study, patients ages 8 through 17 years scheduled for elective laparoscopic cholecystectomy will be invited to participate. Those having da Vinci cholecystectomy procedures will also be eligible. The da Vinci System is a minimally invasive option utilizing robotic technology. Once randomized, the patient will undergo either ultrasound guided bilateral TAP blocks or LWI at the beginning of the surgical procedure. Prospective data regarding pain scores, use of opioid medication, and nausea and vomiting episodes will be collected for both groups. Due to the nature of the study, it will not be possible to blind the investigators to the randomly selected method of injecting local anesthesia; however the personnel involved in the post-anesthetic and post-operative assessment will be blinded to the intervention, as well as the subjects themselves.
Interventions
PROCEDURETAP Blocks
ultrasound guided transversus abdominis plane block utilizing 2.5 mg/kg or 1 mL/kg of 0.2% ropivacaine
PROCEDURElocal wound infiltration
local anesthesia provided at the surgical site utilizing 2.5 mg/kg or 1 mL/kg of 0.2% ropivacaine
Sponsors
Brian Wallace Gray
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Subject, Caregiver)
Eligibility
Sex/Gender
ALL
Age
8 Years to 17 Years
Healthy volunteers
No
Inclusion criteria
1. 8-17 yrs of age at date of enrollment. 2. Elective laparoscopic or da Vinci cholecystectomy scheduled for any diagnostic reason.
Exclusion criteria
1. Chronic pain or chronic use of narcotic or other prescription pain medications. 2. Use of pain medication within 24 hours before surgery 3. Prior major abdominal surgery 4. Evidence of acute inflammation 5. Patients with acute cholecystitis 6. Bleeding / coagulation disorder 7. Seizure disorder 8. Renal dysfunction 9. Infection at injection sites for TAP block or trocar placement 10. Contraindication to LWI or TAP block procedure, as determined by surgeon or anesthesiologist performing the procedure (including, but not limited to, previous incision distorting anatomy or inability to visualize anatomical planes) 11. Any known allergy to medications used in this study 12. Patient unable to verbalize pain score or independently assess pain level 13. Unstable patient in need of emergent intervention at surgeon discretion 14. Patients who are known to be pregnant 15. Patients who are currently prisoners 16. Children in custody of the state 17. Subjects will a BMI \>/= 50 18. Investigator discretion for any other reason
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Amount of narcotic pain medication | 24 hours post-op |
| Time to first request of pain medication | From post-anesthesia care unit (PACU) in time to first pain medication dose, up to 24 hours |
Countries
United States
Outcome results
None listed