Feasibility Study on Pain Control After Laparoscopic Cholecystectomy

NCT ID: NCT03532906

Last Updated: 2021-04-28

Study Results

Results pending

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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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

60 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-07-01

Study Completion Date

2021-04-26

Brief Summary

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The objective of the study is to hopefully understand the most beneficial way to control pain after removing the gallbladder by keyhole surgery (laparoscopic cholecystectomy).

The investigators will investigate two groups of patients undergoing laparoscopic cholecystectomy.

One group will receive the injection of local anaesthetic into the abdominal wall (TAP block) and into the wounds; the second group will have local anaesthetic into the wounds only.

In order to have meaningful results, we anticipate a large number of participants would be required. Therefore we would test first whether it is technically possible to set up the study itself.

The investigators will be looking at parameters (willingness of patients to be recruited, willingness of clinicians to recruit participants, number of eligible patients, follow-up rates, adherence/compliance rates, number of participants needed for an adequate sample size) that will allow to understand if such a larger trial is technically possible to set up.

Detailed Description

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Pain control after laparoscopic cholecystectomy can be achieved with the injection of local anaesthetic into the abdominal wall (TAP block) or into the surgical wounds. There is no reported literature comparing the two techniques with regard to early discharge rate, consumption of oral painkillers and return to daily activities in the week following surgery. In an era where day case surgery has become reality, there is a pressing need for strategies to optimize patients' pathways. In this context the postoperative pain control is a key point.

To compare the two techniques in a randomized trial, a large number of participants would be needed. Therefore the investigators would conduct a pilot study first, to evaluate if further research in the form of a larger study is likely to demonstrate the benefits of the TAP block during laparoscopic cholecystectomy.

During the developing of the research proposal, advice and comments had been given by the local Research and Development Department and the public.

Recruitment

Clinicians will identify potential participants in the surgical outpatient clinic. All patients who fulfil the entry criteria will be invited to take part in the study.

Participants will be fully informed verbally about the proposed study and will receive a Letter of invitation to participant and a Patient information leaflet to take home. That will give them adequate time to read the documents and make an informed choice.

Sample size

As being a feasibility study it is required to have 30 cases per group in the final dataset, with a total of 60 patients.

Consent

Patients will be informed about the study and receive the information leaflet at the time they are enrolled for an elective laparoscopic cholecystectomy in the surgical outpatient clinic. Only once patients are fully informed will they be asked to make a decision to enter the trial. Participants willing to join the study will have written informed consent, on the day of surgery.

Patients will be informed that they do not have to take part in the study if they choose to not be enrolled. Refusal to enter the trial will not compromise their care. Patients will also be informed that if at any time during the study they wish to withdraw they can do so, without having to give a reason and again this will not compromise their care. General Pratictioners will be informed by letter of their patients' inclusion in the study.

Risks and Benefits

There are no additional risks over and above participants' normal clinical care.

Both anaesthetic techniques are currently in use in the Royal Devon and Exeter National Heath System Foundation Trust. The procedures themselves do have potential risks (side-effects) which would be explained routinely to both trial and non-trial patients ahead of surgery. Taking part in this study will not change these risks in any way.

There are no immediate benefits to the participants from taking part in the trial at present. However, if the results are promising, the investigators will run a larger trial that could potentially lead to a new way of looking after patients having laparoscopic cholecystectomy.

That may therefore lead to a future change in medical care that could help patients who will be having laparoscopic cholecystectomy.

The investigators would be clear that no new technique or medication is being tested. Also there is no financial benefit from the study to both the participants and the research team.

Conflicts of Interest

None.

Confidentiality

All data will be stored anonymously against a participant number. Only the clinical team and research nurse will have access to the single table correlating participant's name number. Anonymity will be preserved throughout the trial.

Conditions

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Postoperative Pain

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

OTHER

Blinding Strategy

TRIPLE

Participants Investigators Outcome Assessors

Study Groups

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TAP block

Patients receive the injection of local anaesthetic into the right abdominal wall (TAP block) together with the injection of local anaesthetic into the surgical wounds.

Group Type ACTIVE_COMPARATOR

TAP Block

Intervention Type DRUG

Injection of Bupivacaine 0.5% 20 ml into the thickness of the right abdominal wall and of Bupivacaine 0.5% 10 ml into the surgical wounds.

Control

Patients receive the injection of local anaesthetic into the surgical wounds only.

Group Type OTHER

Control

Intervention Type DRUG

Injection of Bupivacaine 0.5% 10 ml into the surgical wounds

Interventions

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TAP Block

Injection of Bupivacaine 0.5% 20 ml into the thickness of the right abdominal wall and of Bupivacaine 0.5% 10 ml into the surgical wounds.

Intervention Type DRUG

Control

Injection of Bupivacaine 0.5% 10 ml into the surgical wounds

Intervention Type DRUG

Other Intervention Names

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Bupivacaine 0.5% Bupivacaine 0.5%

Eligibility Criteria

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Inclusion Criteria

* Patients able/willing to give informed consent for participation in the study.
* Male or female aged 18-60 years old.

Exclusion Criteria

* Patients having an open cholecystectomy (performed through the standard "rope" incision).
* Patients intended to have laparoscopic cholecystectomy as an inpatient (staying overnight after surgery).
* Patients initially scheduled to have day case surgery but eventually admitted to hospital due to surgical or anaesthetic concerns or social reasons.
* Patients with contraindications in having injection of the local anaesthetic used in the study (i.e. history of side-effects, allergy).
* Patients who cannot have one or more standard oral painkillers prescribed postoperatively.
* Patients with history of chronic pain who are already on long term painkillers.
* Patients unable/unwilling to give informed consent for participation in the study.
Minimum Eligible Age

18 Years

Maximum Eligible Age

60 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Royal Devon and Exeter NHS Foundation Trust

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Antonio Manzelli, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Royal Devon and Exeter NHS Foundation Trust

Locations

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Royal Devon and Exeter NHS Foundation Trust

Exeter, , United Kingdom

Site Status

Countries

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United Kingdom

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.

Reference Type RESULT
PMID: 11576144 (View on PubMed)

Baeriswyl M, Kirkham KR, Kern C, Albrecht E. The Analgesic Efficacy of Ultrasound-Guided Transversus Abdominis Plane Block in Adult Patients: A Meta-Analysis. Anesth Analg. 2015 Dec;121(6):1640-54. doi: 10.1213/ANE.0000000000000967.

Reference Type RESULT
PMID: 26397443 (View on PubMed)

Charlton S, Cyna AM, Middleton P, Griffiths JD. Perioperative transversus abdominis plane (TAP) blocks for analgesia after abdominal surgery. Cochrane Database Syst Rev. 2010 Dec 8;(12):CD007705. doi: 10.1002/14651858.CD007705.pub2.

Reference Type RESULT
PMID: 21154380 (View on PubMed)

Siddiqui MR, Sajid MS, Uncles DR, Cheek L, Baig MK. A meta-analysis on the clinical effectiveness of transversus abdominis plane block. J Clin Anesth. 2011 Feb;23(1):7-14. doi: 10.1016/j.jclinane.2010.05.008.

Reference Type RESULT
PMID: 21296242 (View on PubMed)

De Oliveira GS Jr, Castro-Alves LJ, Nader A, Kendall MC, McCarthy RJ. Transversus abdominis plane block to ameliorate postoperative pain outcomes after laparoscopic surgery: a meta-analysis of randomized controlled trials. Anesth Analg. 2014 Feb;118(2):454-463. doi: 10.1213/ANE.0000000000000066.

Reference Type RESULT
PMID: 24445643 (View on PubMed)

Pourseidi B, Khorram-Manesh A. Effect of intercostals neural blockade with Marcaine (bupivacaine) on postoperative pain after laparoscopic cholecystectomy. Surg Endosc. 2007 Sep;21(9):1557-9. doi: 10.1007/s00464-006-9181-9. Epub 2007 Mar 7.

Reference Type RESULT
PMID: 17342558 (View on PubMed)

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.

Reference Type RESULT
PMID: 19376789 (View on PubMed)

Chazapis M, Walker EM, Rooms MA, Kamming D, Moonesinghe SR. Measuring quality of recovery-15 after day case surgery. Br J Anaesth. 2016 Feb;116(2):241-8. doi: 10.1093/bja/aev413.

Reference Type RESULT
PMID: 26787793 (View on PubMed)

Other Identifiers

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1901750

Identifier Type: -

Identifier Source: org_study_id

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