Transversus Abdominis Plane (TAP) Block for Cesarean Section (CLOTAP)

September 21, 2017 updated by: Laurent Bollag, University of Washington
The purpose of this study is to determine whether a transversus abdominis plane (TAP) block with Clonidine added to the injectate (Clo-TAP) performed approximately 2hrs after the cesarean section (CS) will decrease the amount of postoperative hyperalgesia and ultimately reduce post-CS chronic pain.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Acute severe pain after cesarean section (CS) occurs more often than is thought and 10-15% of the women having a cesarean section develop chronic pain (Kehlet et al. 2006). With over 1.3 million cesarean deliveries per year in the US, this is bound to create a significant health problem. One way to address this health burden is to refine techniques that may help control the pain women experience after CS and ultimately reduce the potential to develop chronic pain.

The purpose of this randomized, double-blinded study is to evaluate the ability of an established anesthetic technique called the transversus abdominis plane (TAP) block to reduce the amount of hyperalgesia women develop around their incision after CS. Measuring the amount of punctuate mechanical hyperalgesia is used as a tool to assess postoperative central sensitization (Lavand'homme et al. 2005), which contributes to postoperative acute pain. Since postoperative acute pain has been shown to be predictive of developing postoperative chronic pain (Eisenach et al. 2008; Yarnitsky et al. 2008), an effective TAP block could help diminish the incidence of chronic pain after CS. In addition, blood samples will be collected for future genetic analysis and we will test preoperatively for mechanical temporal summation (mTS) to evaluate CNS (central nervous system) sensitization and nociceptive system hyperexcitability and see if this correlates with the amount of hyperalgesia women develop around their incision after surgery.

The primary aim of this study is to evaluate the benefits of two different solutions injected by TAP block technique on postoperative peri-incisional hyperalgesia.

Study Type

Interventional

Enrollment (Actual)

90

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Brazil
      • São Paulo, Brazil, 04103-080
        • Hospital e Maternidade Santa Joana
  • United States
    • Washington
      • Seattle, Washington, United States, 98195
        • University of Washington

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 45 years (Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

Female

Description

Inclusion Criteria:

  • non-laboring women who will benefit from and have clinically consented to a scheduled or non-scheduled cesarean delivery under spinal anesthesia
  • English speaking (UW Site) or Portuguese speaking (Brazil site)
  • aged between 18 and 45 years
  • BMI < 40
  • ASA physical status class I or II

Exclusion Criteria:

  • laboring women undergoing a non-scheduled cesarean delivery
  • non-English speaking (UW Site) or non-Portuguese speaking (Brazil site)
  • previous spinal surgery
  • contraindications for neuraxial anesthesia
  • allergy to local anesthetic, ultrasound conduction gel, or Clonidine
  • history of chronic pain
  • inability to receive intraoperative Toradol

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Prevention
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Placebo Comparator: Placebo
Sterile Saline used for TAP block = Bupivacaine Placebo + Clonidine Placebo
Drug: Bupivacaine Placebo
2 x 20mL 0.9% NaCl
Other Names:
  • Sodium Chloride
  • Bupi Placebo
Drug: Clonidine Placebo
2 x 1mL 0.9% NaCl
Other Names:
  • Sodium Chloride
Active Comparator: TAP (Bupi)
2x20mL 0.375% Bupivacaine + 2x1mL of 0.9% NaCl = 150mg Bupivacaine + Clonidine Placebo
Drug: Clonidine Placebo
2 x 1mL 0.9% NaCl
Other Names:
  • Sodium Chloride
Drug: Bupivacaine
2 x 20mL 0.375% Bupivacaine = 150 mg Bupivacaine
Other Names:
  • Bupivacaine Hydrochloride
Active Comparator: Clo-TAP (Bupi + Clon)
2x20mL 0.375% Bupivacaine + 2x1mL Clonidine = 150mg Bupivacaine + 150µg Clonidine
Drug: Bupivacaine
2 x 20mL 0.375% Bupivacaine = 150 mg Bupivacaine
Other Names:
  • Bupivacaine Hydrochloride
Drug: Clonidine
2 x 1ml Clonidine = 150 µg Clonidine
Other Names:
  • Clonidine Hydrochloride

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Wound Hyperalgesia Index (WHA) Assessed 48 Hrs After Block Placement in the Different Groups
Time Frame: 48hrs after CS
Determine which of three different TAP formulations (Placebo, TAP, Clo-TAP) has the most beneficial effect on the postoperative area of hyperalgesia 48hrs after the start of the cesarean section. The smaller the area of WHA, assessed in cm2, the better the outcome. Area sizes may range from 0 to any size.
48hrs after CS

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of Washington

Investigators

  • Principal Investigator: Laurent Bollag, MD, University of Washington
  • Study Chair: Ruth Landau, MD, University of Washington

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

November 1, 2009

Primary Completion (Actual)

August 1, 2010

Study Completion (Actual)

August 1, 2012

Study Registration Dates

First Submitted

November 16, 2009

First Submitted That Met QC Criteria

November 16, 2009

First Posted (Estimate)

November 18, 2009

Study Record Updates

Last Update Posted (Actual)

October 23, 2017

Last Update Submitted That Met QC Criteria

September 21, 2017

Last Verified

September 1, 2017

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 36707

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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