- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02341144
Percutaneous Rectus Sheath Block Versus Intra-operative Rectus Sheath Block for Pediatric Umbilical Hernia Repair
Percutaneous Rectus Sheath Block Versus Intra-operative Rectus Sheath Block for Pediatric Umbilical Hernia Repair: A Prospective, Randomized Study
This is a prospective, double-blinded, randomized controlled study comparing the efficacy of pre-incisional percutaneous rectus sheath block to intra-operative rectus sheath block under direct visualization prior to closure of the incision for providing post-operative analgesia following umbilical hernia repair in children. The current management for reducible umbilical hernias is umbilical hernia repair under general anesthesia as an outpatient procedure.
Patients aged 3-18 years old with a diagnosis of umbilical hernia will be screened for study inclusion. Eligible patients and their parents/guardians will be approached and, if agreeable, consented for the study pre-operatively. Patients will be randomized to receive either pre-incisional percutaneous rectus sheath block by the anesthesiologist or intra-operative rectus sheath block under direct visualization prior to closure of the skin incision by the surgeon. The patient, patient guardians, select research team members, and post-anesthesia care unit (PACU) staff will be blinded to the method of analgesic administration.
Study Overview
Status
Conditions
Detailed Description
Regional anesthesia has been increasingly utilized for providing post-operative analgesia for a number of surgical procedures in children. Rectus sheath block and local anesthetic infiltration of the surgical site are two common modes for providing post-operative analgesia following umbilical hernia repair. Studies comparing the two modes have shown ultrasound-guided rectus sheath block to improve immediate pain scores and reduce use of post-operative analgesia in pediatric patients undergoing umbilical hernia repair. However, these studies have compared pre-incisional ultrasound-guided rectus sheath block to post-operative local anesthetic infiltration as a subcutaneous and/or intradermal injection.
The purpose of the investigators' study is to compare the efficacy of pre-incisional percutaneous rectus sheath block to intra-operative rectus sheath block under direct visualization prior to closure of the skin for providing post-operative analgesia following umbilical hernia repair in children.
The investigators propose a prospective study where pediatric patients who are undergoing elective umbilical hernia repair will be randomized pre-operatively to receive either pre-incisional, ultrasound guided percutaneous rectus sheath block or intra-operative rectus sheath block under direct visualization prior to closure of the skin. The primary outcome is the post-operative pain rating based on the Wong-Baker Faces Pain Rating Scale (WBFPRS) following umbilical hernia repair. Additional outcomes measured will include: operative times, the use of intravenous/oral opioid and/or non-opioid medication in the post-operative period, duration of analgesia following surgery based on time to first rescue analgesic, intra-operative hemodynamic changes, post-operative hemodynamic changes, incidence of side-effects, and complications. Patients/patient guardians will receive a sheet to document post-operative WBFPRS scores, oral opioid and non-opioid medication administration once discharged to home for a total of 5 days.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Florida
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Saint Petersburg, Florida, United States, 33701
- Johns Hopkins All Children's Hospital
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Patients aged 3-18 years undergoing elective umbilical hernia repair
Exclusion Criteria:
- Strangulated or incarcerated umbilical hernia (non-elective)
- Allergy to bupivacaine/ropivicaine
- Concurrent surgical procedures
- Developmental delay or neurologic diagnosis that would interfere with post-operative pain score assessment
- Chronic pain medication use
- Chronic pain disorder or complex regional pain syndrome
- Anesthesiologist classification of III or greater.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Supportive Care
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Pre-op percutaneous rectus sheath block
ultrasound-guided, percutaneous rectus sheath block with ropivacaine by a qualified anesthesiologist
|
Other Names:
After induction of anesthesia, the attending anesthesiologist will use a portable ultrasound probe to locate the rectus sheath.
A 22 gauge needle will be used to inject a predetermined volume of 0.2% ropivacaine (1cc/kg, max dose 10cc, divided into equal doses bilaterally).
The analgesic will be injected percutaneously using ultrasound guidance between the rectus abdominis muscle and the posterior rectus sheath at the lateral border bilaterally.
|
Active Comparator: Intra-operative rectus sheath block
rectus sheath block with ropivacaine under direct visualization by the attending surgeon
|
Other Names:
After the completion of the umbilical hernia repair, after fascial closure, but prior to skin closure, a predetermined volume of 0.2% ropivacaine (1cc/kg, max dose 10c, divided into equal doses bilaterally) will be administered under direct visualization into the rectus sheath bilaterally by the attending surgeon.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Post Operative Pain Rating
Time Frame: from entry in post-anesthesia care unit (PACU) until discharge, estimated 1-2 hours
|
Using the Wong-Baker FACES Pain Rating Scale (WBFPRS)- pain scores range from zero (no pain) to ten (worst pain) and the average score was reported
|
from entry in post-anesthesia care unit (PACU) until discharge, estimated 1-2 hours
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Time to First Narcotic
Time Frame: from entry in post-anesthesia care unit (PACU) to first narcotic
|
duration until patient received first dose of narcotic in PACU
|
from entry in post-anesthesia care unit (PACU) to first narcotic
|
Pain Score of Zero
Time Frame: from entry in the post-anesthesia care unit (PACU) until discharge, estimated 1-2 hours
|
proportion who reported a score of zero throughout their PACU stay using the Wong-Baker (WB) scale with zero being "no pain"
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from entry in the post-anesthesia care unit (PACU) until discharge, estimated 1-2 hours
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PACU Morphine Equivalents
Time Frame: from entry in post-anesthesia care unit (PACU) until discharge, estimated 1-2 hours
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morphine equivalents received in PACU
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from entry in post-anesthesia care unit (PACU) until discharge, estimated 1-2 hours
|
PACU Length of Stay (LOS)
Time Frame: from entry in post-anesthesia care unit (PACU) until discharge, estimated 1-2 hours
|
duration of time spent in the post-anesthesia care unit (PACU) from arrival to discharge
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from entry in post-anesthesia care unit (PACU) until discharge, estimated 1-2 hours
|
Collaborators and Investigators
Investigators
- Principal Investigator: Nicole M Chandler, MD, Johns Hopkins All Children's Hospital
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimated)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Pathologic Processes
- Postoperative Complications
- Pain
- Neurologic Manifestations
- Infant, Newborn, Diseases
- Pathological Conditions, Anatomical
- Hernia, Abdominal
- Hernia
- Hernia, Ventral
- Pain, Postoperative
- Hernia, Umbilical
- Physiological Effects of Drugs
- Central Nervous System Depressants
- Peripheral Nervous System Agents
- Sensory System Agents
- Anesthetics
- Anesthetics, Local
- Ropivacaine
Other Study ID Numbers
- IRB00041103
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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