Optimal Perioperative Pain Control in Minimally Invasive Abdominal Cancer Surgery (LapTAP)
Evaluating Optimal Perioperative Pain Management: A Prospective Randomized Control Trial of Laparoscopic Transversus Abdominis Plane Block With Local Anesthetic, Laparoscopic Transversus Abdominis Plane Block Alone, and Local Anesthetic Alone in Minimally Invasive Oncologic Surgery
This is a research study to evaluate the effectiveness of 3 different types of routine pain management regimens used during clinically indicated, minimally invasive oncologic (cancer) surgery. This project is considered "Research" and participation is voluntary. Upon enrollment in this study, the research team will collect data from the patient's medical records. The patient will undergo all of the normal testing and procedures required pre-operatively (standard of care). The study team will then randomly assign the patient (like a flip of a coin) to one of three different study arms for pain management during surgery:
- Laparoscopic Transversus Abdominis Plane Block (LapTAP) with Local Anesthetic (LA)
- Laparoscopic Transversus Abdominis Plane Block (LapTAP) only
- Local Anesthetic (LA) only The patient will receive standard pre- and post-operative care according to clinical guidelines (routine care). The study team will collect information from the patient's medical record for the first 24 hours after their surgery and upon discharge. This information will include pain scores, amount of medication required, any side effects the patient may have experienced, and satisfaction with pain control. Participation in the study will end upon discharge from the hospital.
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
Study Type
Study Type
Enrollment (Estimated)
Enrollment
Phase
Phase
- Not Applicable
Contacts and Locations
Study Contact
Study Contact
- Name: Casey Allen, MD
- Phone Number: (412) 913-6466
- Email: casey.allen@ahn.org
Study Contact Backup
- Name: AHN Clinical Trials Contact
- Phone Number: 412-913-6466
- Email: clinicaltrials@ahn.org
Study Locations
-
-
Pennsylvania
-
Pittsburgh, Pennsylvania, United States, 15224
- Recruiting
- AHN West Penn Hospital
-
Contact:
- Casey Allen, MD
- Phone Number: (412) 913-6466
- Email: casey.allen@ahn.org
-
Contact:
- AHN Clinical Trials Contact
- Email: clinicaltrials@ahn.org
-
Principal Investigator:
- Casey J Allen, MD
-
Sub-Investigator:
- Joseph Edward, MD
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Male and female patients age ≥ 18 - 89
- Patients scheduled for elective (clinically indicated) hepatic, gastric, biliary, pancreatic, gynecologic, colorectal, other GI Minimally invasive oncologic surgery.
- Patients who have provided informed consent to participate in the study.
- Patients with an American Society of Anesthesiologists (ASA) physical status classification of I, II, or III.
- Patients undergoing procedures anticipated to last more than 1 hour but less than 8 hours.
- Patients able to understand and self-report pain using the designated pain Visual Analog Scale
Exclusion Criteria:
- Patients age less than 18 or ≥ 90
- Pre-existing hepatic dysfunction, cirrhosis
- Patients with an ASA classification of IV or higher.
- Patients with chronic pain disorders or on long-term opioid or analgesic therapy.
- Patients with known contraindications to the study drugs or procedures (e.g., allergy to LA or contraindications to LapTAP).
- Patients with cognitive impairments or psychiatric conditions that could interfere with pain assessment or understanding of informed consent.
- Patients unable to understand the language in which consent and study-related information are provided (The study and the study-related information will be in the English Language)..
- Patients who have undergone major surgery within the last 6 months.
- Female patients who are pregnant.
- Patients currently enrolled in another clinical trial that might interfere with the outcome measures of this study.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Active Comparator: Laparoscopic Transversus Abdominis Plane Block with Local Anesthetic
Patient would be receiving Laparoscopic Transversus Abdominis Plane block in addition to Local Anesthetic per standard of care.
|
For local anesthetic administration at port sites, 30 mL of 0.1% ropivacaine is injected around the umbilical port site following the completion of the primary surgical procedure.
Additionally, 5 mL of 0.1% ropivacaine is injected around each additional port site to ensure effective local anesthesia.
Surgeon will place 18 gauge needle into the fascial plane between the internal oblique and transversus abdominis muscles.
Once the needle is accurately positioned surgeon will inject 15 mL of 0.1% ropivacaine slowly.
This procedure is performed bilaterally to ensure comprehensive analgesia.
The total volume utilized for the LapTAP block is 30 mL of 0.1% ropivacaine.
|
|
Active Comparator: Laparoscopic Transversus Abdominis Plane block only
Patient would be receiving Laparoscopic Transversus Abdominis Plane block without Local Anesthetic per standard of care.
|
Surgeon will place 18 gauge needle into the fascial plane between the internal oblique and transversus abdominis muscles.
Once the needle is accurately positioned surgeon will inject 15 mL of 0.1% ropivacaine slowly.
This procedure is performed bilaterally to ensure comprehensive analgesia.
The total volume utilized for the LapTAP block is 30 mL of 0.1% ropivacaine.
|
|
Active Comparator: Local Anesthetic only
Patient would be receiving Local Anesthetic per standard of care.
|
For local anesthetic administration at port sites, 30 mL of 0.1% ropivacaine is injected around the umbilical port site following the completion of the primary surgical procedure.
Additionally, 5 mL of 0.1% ropivacaine is injected around each additional port site to ensure effective local anesthesia.
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Pain Score
Time Frame: Hourly, starting 1 hour post surgery for 24 hours, then at time of hospital discharge (on average 1 week)
|
Pain will be measured in the post anesthesia care unit (PACU) using Visual Analog Scale.
Pain will be scored from zero to ten, with zero being no pain at all and ten being unbearable pain.
|
Hourly, starting 1 hour post surgery for 24 hours, then at time of hospital discharge (on average 1 week)
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Opioid Consumption
Time Frame: up to 24 hours post surgery
|
Opioid consumption (milligrams) within the first 24 hours post-surgery (standardize with Morphine equivalence).
|
up to 24 hours post surgery
|
|
Recovery Analgesic Time
Time Frame: up to 24 hours post surgery
|
Time to first rescue analgesic request
|
up to 24 hours post surgery
|
|
Adverse Event(s) Frequency
Time Frame: immediately post surgery up through discharge (on average of 1 week)
|
Frequency of any adverse events related to interventions
|
immediately post surgery up through discharge (on average of 1 week)
|
|
Adverse Event(s) Severity
Time Frame: immediately post surgery up through discharge (on average of 1 week)
|
Severity of any adverse events related to interventions
|
immediately post surgery up through discharge (on average of 1 week)
|
|
Patient Satisfaction with Pain Management
Time Frame: At discharge (on average of 1 week)
|
Will gauge patient perceptions of pain control and overall satisfaction with their treatment with a standardized Visual Analog Scale utilizing a zero to ten scale, with zero being completely dissatisfied and ten being completely satisfied.
|
At discharge (on average of 1 week)
|
Collaborators and Investigators
Sponsor
Sponsor
Investigators
Investigators
- Principal Investigator: Casey Allen, MD, Allegheny Health Network
Publications and helpful links
General Publications
- 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.
- El Hachem L, Small E, Chung P, Moshier EL, Friedman K, Fenske SS, Gretz HF 3rd. Randomized controlled double-blind trial of transversus abdominis plane block versus trocar site infiltration in gynecologic laparoscopy. Am J Obstet Gynecol. 2015 Feb;212(2):182.e1-9. doi: 10.1016/j.ajog.2014.07.049. Epub 2014 Aug 1.
- Gan TJ. Poorly controlled postoperative pain: prevalence, consequences, and prevention. J Pain Res. 2017 Sep 25;10:2287-2298. doi: 10.2147/JPR.S144066. eCollection 2017.
- Calle GA, Lopez CC, Sanchez E, De Los Rios JF, Vasquez EM, Serna E, Arango AM, Castaneda JD, Vasquez RA, Gonzalez A, Escobar A, Almanza LA. Transversus abdominis plane block after ambulatory total laparoscopic hysterectomy: randomized controlled trial. Acta Obstet Gynecol Scand. 2014 Apr;93(4):345-50. doi: 10.1111/aogs.12351.
- 17. https://pain.ucsf.edu/fascial-plane-blocks/transversus-abdominis-plane-tap-block
- Jones JH, Aldwinckle R. Interfascial Plane Blocks and Laparoscopic Abdominal Surgery: A Narrative Review. Local Reg Anesth. 2020 Oct 23;13:159-169. doi: 10.2147/LRA.S272694. eCollection 2020.
- Guo Q, Li R, Wang L, Zhang D, Ma Y. Transversus abdominis plane block versus local anaesthetic wound infiltration for postoperative analgesia: A systematic review and meta-analysis. Int J Clin Exp Med. 2015 Oct 15;8(10):17343-52. eCollection 2015.
- Hamid HK, Emile SH, Saber AA, Ruiz-Tovar J, Minas V, Cataldo TE. Laparoscopic-Guided Transversus Abdominis Plane Block for Postoperative Pain Management in Minimally Invasive Surgery: Systematic Review and Meta-Analysis. J Am Coll Surg. 2020 Sep;231(3):376-386.e15. doi: 10.1016/j.jamcollsurg.2020.05.020. Epub 2020 Jun 2.
- Mannava S, Hafezi N, Turk F, Colgate C, Askegard-Giesmann J, Markel T, Horn N, Gray B. Transversus Abdominis Plane Block VS. Local Wound Infiltration for Elective Minimally Invasive Cholecystectomy in Children: A Prospective Randomized Trial. J Pediatr Surg. 2024 Jan;59(1):96-102. doi: 10.1016/j.jpedsurg.2023.09.020. Epub 2023 Sep 22.
- Rajanbabu A, Puthenveettil N, Appukuttan A, Asok A. Efficacy of laparoscopic-guided transversus abdominis plane block for patients undergoing robotic-assisted gynaecologic surgery: A randomised control trial. Indian J Anaesth. 2019 Oct;63(10):841-846. doi: 10.4103/ija.IJA_471_19. Epub 2019 Oct 10.
- Ye SP, Zhu WQ, Huang ZX, Liu DN, Wen XQ, Li TY. Role of minimally invasive techniques in gastrointestinal surgery: Current status and future perspectives. World J Gastrointest Surg. 2021 Sep 27;13(9):941-952. doi: 10.4240/wjgs.v13.i9.941.
- Small C, Laycock H. Acute postoperative pain management. Br J Surg. 2020 Jan;107(2):e70-e80. doi: 10.1002/bjs.11477.
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Estimated)
Primary Completion
Study Completion (Estimated)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Estimated)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Neurologic Manifestations
- Nervous System Diseases
- Neoplasms by Site
- Intestinal Diseases
- Digestive System Neoplasms
- Digestive System Diseases
- Gastrointestinal Diseases
- Neurobehavioral Manifestations
- Intestinal Neoplasms
- Rectal Diseases
- Biliary Tract Diseases
- Liver Diseases
- Colonic Diseases
- Perceptual Disorders
- Pathological Conditions, Signs and Symptoms
- Signs and Symptoms
- Neoplasms
- Biliary Tract Neoplasms
- Colorectal Neoplasms
- Gastrointestinal Neoplasms
- Liver Neoplasms
- Agnosia
- Anesthesia and Analgesia
- Anesthesia, Conduction
- Anesthesia
- Anesthesia, Local
Other Study ID Numbers
Other Study ID Numbers
- LapTAP
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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