Transversus Abdominis Bilateral Plane Block in Total Laparoscopic Hysterectomy : A Randomized Controlled Trial
NCT ID: NCT01596660
Last Updated: 2012-05-11
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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UNKNOWN
NA
200 participants
INTERVENTIONAL
2011-08-31
2012-05-31
Brief Summary
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So far the immediate analgesic management has been made systemically, and the satisfaction reported by patients was high, even though some patients require longer stay in recovery and need higher doses of analgesics before their discharge criteria, allowing an optimal ambulatory management.
There are several treatment options that theoretically could be used but the results have been variable and have failed to demonstrate the expected benefit.
The Transversus Abdominis Plane Block consists in the deposition of local anesthetic in the plane between the internal oblique and transverse abdominal, looking to infiltrate the spinal nerves at this level, so the innervation to the skin, muscles and the parietal peritoneum will be interrupted. The TAP Block was first described in 2001 , based on anatomy marks techniques of the peripheral nerves and was developed and evaluated later by McDonnell et al.
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Detailed Description
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The blockage in the abdominal transverse plane is a single entry in the triangle of Petit, to access a greater number of nerves that allow a wider spread of analgesia. The innervation of the anterolateral abdominal wall is given by the anterior branches of spinal nerves T7 to L1 (these include the intercostal nerves T7 at 11, the nerve subcostal nerve T12 and ilio hypogastric and ilio inguinal L1
The anterior divisions of the nerves T7 to T11 continues from the intercostal space and enter the abdominal wall between the internal oblique and transversus abdominis, reaching the rectus abdominis, which pierce and innervate the skin of the anterior abdominal region. In its course also innervate the external oblique muscle via the lateral cutaneous branch is divided into anterior and posterior innervating the external oblique and dorsal latium
The anterior branch of T12 is connected to the ilio hypogastric nerve and gives branch to the piriformis muscle, the lateral cutaneous branch pierces the internal and external oblique muscles and descends over the iliac crest innervate the anterior part of the buttocks.
The ilio hypogastric nerve,L1, is divided between the internal oblique and transversus abdominis near the iliac crest in two anterior and lateral cutaneous branches, the first innervate the skin of the buttocks and the second the hypogastric region.
The ilio inguinal nerve communicates with the ilio hypogastric nerve between the internal oblique and transversus abdominis, near the anterior iliac crest and innervates the anterior and medial thigh and part of the skin covering the genitals.
The aim of the nerve block is to deposit local anesthetic in the plane between the internal oblique and transverse abdominal looking to infiltrate the spinal nerves at this level, so the skin innervation on muscle and parietal peritoneum will interrupted. Obviously if the surgery goes through the peritoneal cavity, visceral pain will not be interrupted.
This block is indicated in any lower abdominal surgery and has been used effectively in laparoscopic surgery, so far no work described in LH, this block allows analgesia from T7 to L1 even with minimal side effects, low cost, without altering surgical time, and low risk. Among the complications described above, a puncture of the liver in a patient with liver elongated and some small punctures without serious consequences.
The ambulatory management could be more efficient with the use of blockage in the abdominal transverse plane (TAP Block) with local anesthetic. In order to study the benefits that the TAP Block could offer to our patients, we suggest a randomized controlled trial comparing the blockage in the abdominal transverse plane with placebo.
Conditions
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Study Design
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RANDOMIZED
PARALLEL
TREATMENT
TRIPLE
Study Groups
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Bupivacaina
20 cc of bupivacaine 0.5% in 20 cc de saline solution and it is infiltrated 20 cc each side.
Bupivacaina 0.5%
Bupivacaina 0.5% 20cc
saline solution
20 cc of saline solution 0.9% to infiltrate each side.
placebo comparator
20 cc of saline solution 0.9%, to infiltrate each side.
Interventions
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Bupivacaina 0.5%
Bupivacaina 0.5% 20cc
placebo comparator
20 cc of saline solution 0.9%, to infiltrate each side.
Other Intervention Names
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Eligibility Criteria
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Inclusion Criteria
* ASA 1 and 2
* Patients without contraindications to the administration of local anesthetics
* Patients without contraindications to NSAIDs or acetaminophen.
* Patients with no simultaneous intervention (only laparoscopic hysterectomy)
* Patients living in the metropolitan area, with telephone line, can be contacted by telephone in the first 72 hours by calling 24, 48 and 72 hours, conducted by researchers at the number previously reported by the patient.
* An adequate level of understanding, ie patients who are able to communicate by telephone and understand a numerical scale.
* Who agree to participate in the work.
Exclusion Criteria
* Patients who are hospitalized after total laparoscopic hysterectomy.
* Patients with a body mass index above 30.
* Laparoscopic hysterectomy with a longer duration to 120 minutes.
* Patients who do not they can be reached by phone at pre-set times.
30 Years
70 Years
FEMALE
No
Sponsors
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CES University
OTHER
Responsible Party
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Gustavo Adolfo Calle Gomez
Principal investigator
Principal Investigators
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Gustavo A Calle, MD
Role: STUDY_DIRECTOR
CES University
Locations
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Universidad CES
Medellín, Antioquia, Colombia
Countries
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Central Contacts
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Facility Contacts
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References
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Rafi AN. Abdominal field block: a new approach via the lumbar triangle. Anaesthesia. 2001 Oct;56(10):1024-6. doi: 10.1046/j.1365-2044.2001.02279-40.x. No abstract available.
Jokela R, Ahonen J, Tallgren M, Haanpaa M, Korttila K. A randomized controlled trial of perioperative administration of pregabalin for pain after laparoscopic hysterectomy. Pain. 2008 Jan;134(1-2):106-12. doi: 10.1016/j.pain.2007.04.002. Epub 2007 May 15.
Lenz H, Sandvik L, Qvigstad E, Bjerkelund CE, Raeder J. A comparison of intravenous oxycodone and intravenous morphine in patient-controlled postoperative analgesia after laparoscopic hysterectomy. Anesth Analg. 2009 Oct;109(4):1279-83. doi: 10.1213/ane.0b013e3181b0f0bb.
Scharine JD. Bilateral transversus abdominis plane nerve blocks for analgesia following cesarean delivery: report of 2 cases. AANA J. 2009 Apr;77(2):98-102.
Malhotra N, Chanana C, Roy KK, Kumar S, Rewari V, Sharma JB. To compare the efficacy of two doses of intraperitoneal bupivacaine for pain relief after operative laparoscopy in gynecology. Arch Gynecol Obstet. 2007 Oct;276(4):323-6. doi: 10.1007/s00404-007-0337-1. Epub 2007 Jul 25.
de Lapasse C, Rabischong B, Bolandard F, Canis M, Botchorischvili R, Jardon K, Mage G. Total laparoscopic hysterectomy and early discharge: satisfaction and feasibility study. J Minim Invasive Gynecol. 2008 Jan-Feb;15(1):20-5. doi: 10.1016/j.jmig.2007.08.608.
McDonnell JG, Curley G, Carney J, Benton A, Costello J, Maharaj CH, Laffey JG. The analgesic efficacy of transversus abdominis plane block after cesarean delivery: a randomized controlled trial. Anesth Analg. 2008 Jan;106(1):186-91, table of contents. doi: 10.1213/01.ane.0000290294.64090.f3.
Niraj G, Searle A, Mathews M, Misra V, Baban M, Kiani S, Wong M. Analgesic efficacy of ultrasound-guided transversus abdominis plane block in patients undergoing open appendicectomy. Br J Anaesth. 2009 Oct;103(4):601-5. doi: 10.1093/bja/aep175. Epub 2009 Jun 26.
El-Dawlatly AA, Turkistani A, Kettner SC, Machata AM, Delvi MB, Thallaj A, Kapral S, Marhofer P. Ultrasound-guided transversus abdominis plane block: description of a new technique and comparison with conventional systemic analgesia during laparoscopic cholecystectomy. Br J Anaesth. 2009 Jun;102(6):763-7. doi: 10.1093/bja/aep067. Epub 2009 Apr 17.
McDonnell JG, O'Donnell B, Curley G, Heffernan A, Power C, Laffey JG. The analgesic efficacy of transversus abdominis plane block after abdominal surgery: a prospective randomized controlled trial. Anesth Analg. 2007 Jan;104(1):193-7. doi: 10.1213/01.ane.0000250223.49963.0f.
O'Donnell BD, McDonnell JG, McShane AJ. The transversus abdominis plane (TAP) block in open retropubic prostatectomy. Reg Anesth Pain Med. 2006 Jan-Feb;31(1):91. doi: 10.1016/j.rapm.2005.10.006. No abstract available.
Jankovic ZB, Pollard SG, Nachiappan MM. Continuous transversus abdominis plane block for renal transplant recipients. Anesth Analg. 2009 Nov;109(5):1710-1. doi: 10.1213/ANE.0b013e3181ba75d1. No abstract available.
Fredrickson MJ, Seal P. Ultrasound-guided transversus abdominis plane block for neonatal abdominal surgery. Anaesth Intensive Care. 2009 May;37(3):469-72. doi: 10.1177/0310057X0903700303.
Niraj G, Kelkar A, Fox AJ. Application of the transversus abdominis plane block in the intensive care unit. Anaesth Intensive Care. 2009 Jul;37(4):650-2. doi: 10.1177/0310057X0903700420.
Preliminary experience with transversus abdominis plane block for postoperative pain relief in infants and children
Other Identifiers
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1-JMejia
Identifier Type: -
Identifier Source: org_study_id
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