Transversus Abdominis Plane (TAP) Block Laparoscopic Hysterectomy (TAP HYS)

Northwestern University

Status: Completed

Conditions: Postoperative Pain

Treatments: Drug: Drug .5% Ropivacaine; Drug: 20 cc of 0.25% ropivacaine; Drug: Placebo

Study type: Interventional

Funder types: Other

Identifiers

NCT01074229

STU00023440

Details and patient eligibility

About

The transversus abdominis plane (TAP) block involves the sensory nerve supply of the anterior -lateral abdominal wall where the T7-12 intercostal nerves, ilioinguinal, iliohypogastric and the lateral cutaneous branches of the dorsal rami of L1-3 are blocked with an injection of local anesthetic between the internal oblique abdominal muscle (IOAM) and the transverse abdominal muscle(TAM)This technique allows sensory blockade of the anterolateral abdominal wall via local anesthetic deposition superficial to the transversus abdominis muscle. It was first described by McDonnell et al. as a landmark technique to provide analgesia for lower abdominal surgery.

Hebbart et al. subsequently described an ultrasound guided technique for the TAP block which they named posterior TAP block. The ultrasound allows identification of the external oblique abdominal muscles (EOAM),IOAM and TAM. Previous studies about ultrasound -guided regional anesthetic techniques suggest improved block quality and safety, which is primarily due to direct visualization of the relevant anatomy, the tip of the needle, and the spread of the local anesthetics.

Clinical trials of the single shot posterior TAP block have shown a significant reduction in morphine consumption during the first 24-36 hours after surgery. More recently, El-dawlatly et al. demonstrated that ultrasound guided TAP block in patients undergoing laparoscopic cholecystectomy reduced perioperative opioid consumption by more than 50%.

This is the first study to evaluate the effect of TAP block in the quality of recovery in patients undergoing laparoscopic hysterectomy and may help the pathway to make this an outpatient procedure.

Enrollment: 75 patients

Sex: Female

Ages: 18 to 64 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Age: 18-64 years
• Surgery: Laparoscopic Hysterectomy surgery
• ASA status: I and II
• Fluent in English

Exclusion criteria

• History of allergy to local anesthetics
• History of chronic opioid use
• Pregnant patients
• BMI greater than 30

Drop-out criteria:

• Patient or surgeon request
• Complications related to the procedure

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Triple Blind

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75 participants in 3 patient groups, including a placebo group

Placebo

Placebo Comparator group

Description:

sterile normal saline as placebo

Treatment:

Drug: Placebo

Drug .5% Ropivacaine

Active Comparator group

Description:

Instillation of 20 cc of 0.5% ropivacaine

Treatment:

Drug: Drug .5% Ropivacaine

20 cc of 0.25% ropivacaine

Active Comparator group

Description:

Instillation of 20 cc of 0.25% ropivacaine

Treatment:

Drug: 20 cc of 0.25% ropivacaine