- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02292667
Efficacy of the Ultrasound-guided Transversus Abdominis Plane Block in Open Aortic Abdominal Aneurysm Repair Surgery (ETAP)
Efficacy of the Ultrasound-guidedTransversus Abdominis Plane (TAP) Block on Postoperative Pain Control in Open Aortic Abdominal Aneurysm Repair Surgery
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
The open repair of abdominal aortic aneurysm (AAA) is a painful surgery. Patients suffering from AAA are at high risk of perioperative cardiovascular and pulmonary complications. It has been previously suggested that a bad perioperative pain control could increase the incidence of such complications.
Intravenous patient-controlled analgesia (PCA) with morphine is widely considered as the gold standard treatment of the postoperative pain in open repair of AAA. High dose of morphine are often required and could delay the postoperative recovery and discharge. Side effects of morphine, such as respiratory depression, nausea, vomiting or pruritus, are responsible for patient discomfort and dissatisfaction when high doses are used.
The efficacy of the ultrasound-guided transversus abdominis plane (TAP) block has been described for pain management following abdominal surgery, such as gastrectomy or kidney transplantation. The efficacy of the association of TAP block and PCA with morphine was higher than multimodal intravenous analgesia including PCA with morphine and than the combination of PCA with morphine and epidural analgesia. To our knowledge, the efficacy of the ultrasound-guided TAP block has never been studied for the postoperative pain control in AAA surgery.
Study Type
Enrollment (Anticipated)
Phase
- Phase 3
Contacts and Locations
Study Contact
- Name: Julien Chenet, MD
- Phone Number: +33(0)622640818
- Email: julchenet@gmail.com
Study Contact Backup
- Name: Guillaume Besch, MD
- Phone Number: +33(0)677897039
- Email: guillaume.besch@gmail.com
Study Locations
-
-
Doubs
-
Besançon, Doubs, France, 25000
- Recruiting
- CHU Besançon
-
Contact:
- Julien Chenet, MD
- Phone Number: +33381669121
- Email: julchenet@gmail.com
-
Contact:
- Guillaume Besch, MD
- Phone Number: +33381668166
- Email: guillaume.besch@gmail.com
-
Principal Investigator:
- Julien Chenet, MD
-
Sub-Investigator:
- Emmanuel SAMAIN, MD
-
Sub-Investigator:
- Sébastien Pili-Floury, MD
-
Sub-Investigator:
- Simon Rinckenbach, MD
-
Sub-Investigator:
- Guillaume BESCH, MD
-
Sub-Investigator:
- Thomas Levy, MD
-
Sub-Investigator:
- Eviane Farah, MD
-
Sub-Investigator:
- Angeline Chopard-Guillemin, MD
-
Sub-Investigator:
- Marie-Hélène Tripard, MD
-
Sub-Investigator:
- Patrick Lemounaud, MD
-
Sub-Investigator:
- Mazen Al Sayed Obeid, MD
-
Sub-Investigator:
- Emilie Ducroux, MD
-
Sub-Investigator:
- Stéphanie Villeminey, MD
-
Sub-Investigator:
- Vincenzo Ritucci, MD
-
Sub-Investigator:
- Vivien Salignon
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- ASA (American Society of Anesthesiologists) physical status 1, 2 or 3
- Elective surgery for open repair of an aortic abdominal aneurysm performed in the Vascular Surgery Unit of the University Hospital of Besancon
- Informed consent given
- Health medical insurance affiliation
Exclusion Criteria:
- Poor adherence to protocol attended
- Incapacity to consent
- Pregnancy and/or breast feeding
- Endovascular repair of aortic abdominal aneurysm
- Emergent surgery of a rupture or a fissuration of aortic abdominal aneurysm
- Chronic medical treatment by clopidogrel if clopidogrel not stopped 5 days before surgery at least
- Chronic medical treatment by prasugrel if prasugrel not stopped 7 days before surgery at least
- Chronic medical treatment by ticlopidine, inhibitors of phosphodiesterase , inhibitors of glycoprotein IIb/IIIa, adenosine triphosphate analogs or thrombin receptor antagonists
- Congenital or acquired bleeding disorder
- Incapacity to use patient-controlled analgesia device
- Chronic opioid abuse or dependence
- Chronic renal failure defined as a clearance < 30 ml/min
- Severe hepatic failure
- Other contraindications to ropivacaïne (allergy, medical history of porphyria, hypovolemia)
- Contraindications to acetaminophen
- Contraindications to morphine
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: TAP BLOCK
Patients included in the ETAP group will receive the combination of a bilateral ultrasound-guided Transversus Abdominis Plane (TAP) block and a multimodal intravenous analgesia protocol for the postoperative pain management after the surgical open repair of an aortic abdominal aneurysm. The TAP block consists in 2 ultrasound-guided injections of Ropivacaine 0.375% on each side of the abdominal wall between the internal oblique and transversus abdominis muscles: 1 subcostal injection and 1 supra-iliac injection (i.e 10 ml of Ropivacaine 0.375% by injection). The multimodal intravenous analgesia protocol consists in the association of intravenous infusion of 1 g of Acetaminophen every 6 h and intravenous patient-controlled analgesia (PCA) with Chlorhydrate of Morphine 1 mg/ml. |
The aim of the Transversus Abdominis Plane (TAP) Block is to deposit local anesthetic in the plane between the internal oblique and the transversus abdominis muscles targeting the spinal nerves in this plane.
The local anesthetic used in the ETAP study is Ropivacaine 0.375%. 2 ultrasound-guided injections of 10 ml will be performed on each side of the abdominal wall: 1 subcostal injection and 1 supra-iliac injection.
Other Names:
Doses of 1 mg of Chlorhydrate of Morphine will be delivered intravenously by the Patient Controlled Analgesia (PCA) pump.
The PCA pump is a computerized pump which contains a syringe of 1 mg/ml of Chlorhydrate of Morphine as prescribed by the physician in charge of the patient, and connected directly to a patient's intravenous line.
Doses of Chlorhydrate of Morphine can be self-administered by the patient as needed by the having the patient press a button.
Other Names:
1 g of Acetaminophen will be given intravenously each 6 h during 48 hours after the surgical procedure.
Other Names:
|
Active Comparator: CONTROL
Patients included in the CONTROL group will receive a multimodal intravenous analgesia protocol alone for the postoperative pain management after the surgical open repair of an aortic abdominal aneurysm. The multimodal intravenous analgesia protocol consists in the association of intravenous infusion of 1 g of Acetaminophen every 6 h and intravenous patient-controlled analgesia (PCA) with Chlorhydrate of Morphine 1 mg/ml. |
Doses of 1 mg of Chlorhydrate of Morphine will be delivered intravenously by the Patient Controlled Analgesia (PCA) pump.
The PCA pump is a computerized pump which contains a syringe of 1 mg/ml of Chlorhydrate of Morphine as prescribed by the physician in charge of the patient, and connected directly to a patient's intravenous line.
Doses of Chlorhydrate of Morphine can be self-administered by the patient as needed by the having the patient press a button.
Other Names:
1 g of Acetaminophen will be given intravenously each 6 h during 48 hours after the surgical procedure.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Morphine consumption during the first postoperative 24 hours
Time Frame: 24 hours
|
The morphine consumption during the first postoperative 24 hours is the total dose of morphine delivered both by the patient-controlled analgesia device and during the titration of morphine by the nurse in the post-anesthesia care unit.
|
24 hours
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Delay between the last peroperative injection of opioid and the first administration of morphine in the post-anesthesia care unit
Time Frame: 24 hours
|
24 hours
|
|
Morphine consumption during the first postoperative 48 hours
Time Frame: 48 hours
|
The morphine consumption during the first postoperative 48 hours is the total dose of morphine delivered both by the patient-controlled analgesia device and during the titration of morphine by the nurse in the post-anesthesia care unit.
|
48 hours
|
Pain intensity at rest assessed by the visual analog scale for pain
Time Frame: 48 hours
|
48 hours
|
|
Pain intensity at mobilisation assessed by the visual analog scale for pain
Time Frame: 48 hours
|
48 hours
|
|
Percentage of patients suffering from insomnia during the first and/or the second postoperative night
Time Frame: 48 hours
|
48 hours
|
|
Percentage of patients suffering from awakenings during the first and/or the second postoperative night
Time Frame: 48 hours
|
48 hours
|
|
Incidence of morphine side effects
Time Frame: 48 hours
|
Morphine side effects include: nausea, vomiting, pruritus, drowsiness, respiratory depression
|
48 hours
|
Incidence of TAP block side effects
Time Frame: 48 hours
|
TAP block side effects are any side effect occuring in the ETAP group and considered to be related to the TAP block by the safety board of the study.
|
48 hours
|
Ropivacaine sides effects
Time Frame: 48 hours
|
Ropivacaine sides effects are: cardiac toxicity, neurologic toxicity, allergy
|
48 hours
|
Post-operative morbidity
Time Frame: Day 30
|
Any of the following events occuring within the 30 first post-operative days: myocardial infarction, acute congestive heart failure, ventricular tachycardia, ventricular fibrillation, atelectasis, pneumonia, acute respiratory failure requiring invasive or non invasive mechanical ventilation, acute kidney failure, non infectious systemic inflammatory response syndrome, sepsis, surgical wound complication.
|
Day 30
|
30-day survival
Time Frame: Day 30
|
Day 30
|
|
Duration of hospital stay
Time Frame: Expected average of 10 days
|
Patients will be followed for the duration of hospital stay, an expected average of 10 days.
|
Expected average of 10 days
|
Collaborators and Investigators
Investigators
- Principal Investigator: Julien Chenet, MD, Centre Hospitalier Régional Universitaire de Besançon
Publications and helpful links
Study record dates
Study Major Dates
Study Start
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Cardiovascular Diseases
- Vascular Diseases
- Aortic Diseases
- Aneurysm
- Aortic Aneurysm
- Aortic Aneurysm, Abdominal
- Physiological Effects of Drugs
- Central Nervous System Depressants
- Peripheral Nervous System Agents
- Analgesics
- Sensory System Agents
- Analgesics, Non-Narcotic
- Antipyretics
- Analgesics, Opioid
- Narcotics
- Acetaminophen
- Morphine
Other Study ID Numbers
- API/2014/52
- 2014-003665-20 (EudraCT Number)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
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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