Intraoperative TAP Block and Post-operative Pain Control for Minimally Invasive Hysterectomy

• Status: Not yet recruiting
• Trial end date: 2024-05-31
• Target enrollment: 0
• Participant gender: Female

Summary

Modern postoperative pain management aims to optimizing pain relief while minimizing opiate usage. While opiates are effective for pain relief, they result in common adverse effects such as nausea, constipation, and urinary retention, and most importantly present a long-term risk of abuse and dependency [1,2]. Commonly used approaches include non-opiate pain medications such as acetominophen and non-steroidal anti-inflammatory agents, as well as regional nerve blocks such as epidurals [3].

The transversus abdominis plane (TAP) block is a fascial plane block performed by injecting local anesthetic into the plane superficial to the transversus abdominis muscle where the anterior rami of the spinal nerves course to provide sensory innervation to the abdominal wall. The injections are generally placed either subcostally or at the midaxillary line bilaterally [4-6]. The TAP block has been shown to be effective in reducing pain scores and opiate usage in some randomized studies but not others in patients undergoing various abdominal surgeries [7]. There is great variation in method of administration, sites injected, and local anesthetics used, which may in part account for the heterogeneity of trial results.

• Phase: Phase 3
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: Tufts Medical Center
• Treatments: Bupivacaine

Criteria

Inclusion Criteria:

1. Age 18-80

2. Patients undergoing laparoscopic or robotic hysterectomy; may include other procedures (e.g. lymph node removal); for benign or malignant indications

3. Able to consent to study

Exclusion Criteria:

1. Known clinically significant allergy to bupivacaine or liposomal bupivacaine

2. ASA IV or V

3. Emergency surgery

4. Current chronic opiate use

5. Current pregnancy or breastfeeding

6. Severe hepatic or renal impairment