Comparison of two TAP block approaches when used to control pain of colorectal post-operative patients

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"Transverse abdominus plane nerve block (TAP), ropivacaine, catheter or single injection TAP, liposomal bupivacaine, and no catheter"
Age:
18 to 90 years old
Gender:
Any
Healthy Volunteers:
No
Keywords:
colorectal surgery
Type:
Drug study, Phase 4
Investigator:
Description
Pain control after laparoscopic surgery of the abdomen is complex and has different components. Opioids, which are drugs similar to morphine, have long been used to treat pain postoperatively. Although they are effective, they have risks and side effects that can lengthen hospital stay including nausea, itching, constipation, and breathing problems. Other ways of treating postoperative pain include medications such as acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs, and performing peripheral nerve blocks.

Peripheral nerve blocks have long been used to decrease post-operative pain. In abdominal surgery, a widely used nerve block is the transverse abdominus plane block (TAP). At UC Davis, it is standard practice for adult colorectal surgery patients to receive TAP blocks with catheters using a local anesthetic called ropivacaine to improve pain control and decrease the need for opioids. These catheters are usually removed after two days. The alternative single injection TAP block can also be performed using a different local anesthetic called liposomal bupivacaine (Exparel). The purpose of this study is to compare the effectiveness and cost of the two TAP block approaches when used for post-operative pain control in colorectal surgery.
We think patients receiving either one of the TAP block approaches will have satisfactory pain control and that side effects of both approaches will be similar. However, we think that the single injection TAP block approach with liposomal bupivacaine may be more effective (as measured by less need for morphine-like medication) in controlling pain compared to TAP block with a catheter approach. Finally, we also think medical utilization cost may be lower with the single injection approach. The results of this study could improve the care for colorectal surgery patients at UC Davis and possibly other institutions.
This study requires
Single injection TAP block or TAP block with catheters

Throughout your hospitalization, certain information will be collected by our team: ultrasound images from your TAP block, anesthesia record during your surgery, amount of opioids required at different stages of your hospital stay, incidence of side effects such as nausea/vomiting, your reported pain scores, and total time spent in the PACU and inpatient unit.
Who can participate?
Inclusion Criteria:

- Patients scheduled for elective colorectal surgery with Dr. Linda Farkas


Exclusion Criteria:

- Patients under 18 years of age

- Patient over 90 years of age

- Pregnancy

- Prisoners

- Patients unable to provide consent

- Patients on systemic anticoagulation therapy

- Patients with an allergy to local anesthetics
Resources
Schedule
Study duration and period
Two hours prior to surgery until discharge from hospital
Recruitment period
From March 7, 2017
Location
UC Davis Medical Center
2315 Stockton Boulevard
Sacramento, CA 95817
Research Topic
Conditions:
  • Colorectal Surgery
  • TAP Blocks

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