- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03570996
A Trial Comparing Transversus Abdominis Plane Catheter Versus Epidural After Esophagectomy
A Randomized Controlled Trial Comparing Transversus Abdominis Plane Catheter Versus Epidural After Esophagectomy
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Epidural analgesia is considered the 'gold standard' for post-operative analgesia following open esophagectomy. Epidurals have been shown to reduce post-operative pulmonary morbidity and mortality. However, epidurals are often associated with sympathetic blockade that creates hypotension and could therefore adversely affect the conduit. Pain management techniques that use peripheral nerve blockade are becoming more prevalent, reducing the need for an epidural. Transversus abdominis plane (TAP) catheters have been used in colorectal and abdominal surgery showing equivocal pain scores to epidurals. With the minimally invasive chest approach, the analgesia coverage focuses on the abdominal incision where both epidurals and TAPs are considered standard of care.
The investigators have completed a retrospective study in preparation for a randomized control trial. The investigators previous retrospective study found that TAP blocks/catheters are a reasonable alternative to epidurals, providing adequate pain coverage for abdominal incisions. The study found no statistical difference in pain scores between the two groups. The TAP group had a lower prevalence of hypotension and lower crystalloid resuscitation needs. Pulmonary complications were similar between the two groups. This retrospective review showed that TAP blocks are a reasonable alternative to epidurals and may reduce episodes of hypotension. The investigators aim is to now expand this study to a randomized control trial.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Washington
-
Seattle, Washington, United States, 98104
- Swedish Cancer Institute
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- All adult individuals who undergo an esophagectomy with a minimally invasive approach of the chest at Swedish Medical Center-First Hill. These approaches include:
- 3 hole with R video-assisted thoracoscopic surgery (VATS)
- Ivor Lewis R VATS
- Transhiatal
Exclusion Criteria:
- Age <18
- Unable to consent
- Additional surgical procedures planned
- Patient with chronic pain on a daily regimen of narcotics
- Patients who remain intubated greater than 24 hours post operatively
- Non-English speaking
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Sequential Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Transversus abdominis plane catheter
Transversus abdominis plane catheter (TAP) for pain control in esophagectomy operations.
TAP group will have bilateral subcostal TAP catheters and single shot bilateral rectus sheath blocks placed at the end of the surgery, prior to emergence.
Bilateral subcostal TAP catheters will be bolused with 20ml of .2%
ropivacaine on each side and then infused with .2%
ropivacaine at 10ml/ hr for 75 hours each.
Rectus sheath blocks will be bilateral bolus 20ml of .2%
ropivacaine.
|
Esophagectomy with minimally invasive approach of the chest including: 3 hole with R video-assisted thoracoscopic surgery (VATS), Ivor Lewis R VATS, Transhiatal
TAP group will have bilateral subcostal TAP catheters and single shot bilateral rectus sheath blocks placed at the end of the surgery, prior to emergence.
Bilateral subcostal TAP catheters will be bolused with 20ml of .2%
ropivacaine on each side and then infused with .2%
ropivacaine at 10ml/ hr for 75 hours each.
Rectus sheath blocks will be bilateral bolus 20ml of .2%
ropivacaine
Other Names:
|
Active Comparator: epidural
Epidural pain control for pain control in esophagectomy operation.
Patients randomize the TEP group will have bilateral TEP placed at T8-9 +/- one level based on patient anatomy.
TEP will be bolused with 5ml of 1.5% lidocaine with epinephrine and then started on infusion of .0625%
bupivacaine plus 4 mcg/ml fentanyl plus 2 mcg/ ml epinephrine at 6ml/hr with a range of 6-12 ml/hr, titrating to optimize patient comfort.
Epidurals are placed before surgery start time.
|
Esophagectomy with minimally invasive approach of the chest including: 3 hole with R video-assisted thoracoscopic surgery (VATS), Ivor Lewis R VATS, Transhiatal
Patients randomize the TEP group will have bilateral TEP placed at T8-9 +/- one level based on patient anatomy.
TEP will be bolused with 5ml of 1.5% lidocaine with epinephrine and then started on infusion of .0625%
bupivacaine plus 4 mcg/ml fentanyl plus 2 mcg/ ml epinephrine at 6ml/hr with a range of 6-12 ml/hr, titrating to optimize patient comfort.
Epidurals are placed before surgery start time.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Pain scores
Time Frame: Up to post-operative day 4
|
Pain scores on a scale of 0-10 will be collected from patients twice a day
|
Up to post-operative day 4
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Volume Resuscitation
Time Frame: Up to post-operative day 4
|
Amount of fluids given to patient
|
Up to post-operative day 4
|
Hypotension
Time Frame: Up to post-operative day 4
|
Total episodes of hypotension
|
Up to post-operative day 4
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Brian E Louie, MD, Swedish Cancer Institute and Medical Center
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
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
Other Study ID Numbers
- STUDY2017000592
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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