- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05177991
Post-operative Pain Control-TAP Block Using Exparel vs. Marcaine for Hernia Repairs
The Evaluation of Post-operative Pain Control With a TAP Block Using Exparel vs. Marcaine for Hernia Repairs
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Approximately 200 patients in the study will be randomized to one of two arms: TAP block with Exparel or TAP block with bupivacaine. Randomization will be performed using a permuted block randomization algorithm (Ex. AABBABABABBABBAA, where A=Exparel group and B=Bupivacaine group). Only the participant will be blinded to the arm assignment as the knowledge of the assignment for the surgeon and anesthesiologist is needed. The bilateral TAP block will be performed by the department of anesthesia under ultrasound guidance using 20cc of local anesthetic per side. Additional local anesthetic will be supplied by the surgeon at the incision sites. Both of these anesthetics being evaluated and the dosage are commonly administered as standard of care (SOC). The choice of anesthetic used is up to the discretion of the surgeon in most instances. The patients will be blinded to which local anesthetic they receive. Operative technique will be standardized amongst all participating surgeons.
All patients with ventral hernias will undergo an IPOM+ technique detailed by primary closure of the defect in addition to circumferential mesh fixation with a running suture. Three or four trochars will be used ranging from 5-12mm in size. Mesh selection will be at the discretion of the surgeon with a minimum of 5cm overlap of the original defect in all directions. Defect size will be measured intraoperatively with a ruler intra-abdominally.
All patients with an inguinal hernia will undergo a transabdominal preperitoneal hernia repair with mesh placement. Three or four trochars ranging from 5-12mm will be used. Size of mesh and fixation of mesh at one or two points will be at the surgeon's discretion. The length of surgery will be recorded.
The patients will be given a packet of VAS pain assessments to take home with pre-marked time intervals to fill out at 2h, 6h, and 12h post operatively as well as every 12 hours thereafter. The patients will also be asked to record how many narcotic medications they will be consuming on a daily basis. Our team will contact patients daily to collect the data verbally which will also serve as a reminder to patients to complete this task faithfully. Each patient will follow up at one week and provide the surgeons with the packet of VAS assessments as well as bring in any excess narcotics that they did not consume. Each patient will also be told to take tylenol 500mg every 6 hours for the first 96 hours and to record whether they take any additional alternative pain medications (NSAIDs, muscle relaxants, gabapentinoids). Upon discharge, patients will be prescribed 15 pills of 5mg hydrocodone-325mg acetaminophen to be taken every 6 hours as needed for severe pain.
Data collection will include demographics of the patients including age, sex, ASA status, height/weight, BMI, preoperative pain level and previous abdominal surgeries. Intraoperative variables will include defect size, ventral vs. inguinal, number of trochar, mesh size and type, operative time. Postoperative collection will include pain scores as outlined above and narcotic use. Data analysis will include differences, if any, in post operative pain scores as well as narcotic use. This will be stratified to the inguinal hernia group vs. ventral hernias and the ventral hernia group will be stratified to size of defect and length of surgery.
Study Type
Enrollment (Estimated)
Phase
- Early Phase 1
Contacts and Locations
Study Contact
- Name: Christine LeBoeuf, DNP
- Phone Number: 225-765-5956
- Email: christine.leboeuf@fmolhs.org
Study Contact Backup
- Name: Jill Tomkins, MS
- Phone Number: 225-765-7979
- Email: jill.tomkins@fmolhs.org
Study Locations
-
-
Louisiana
-
Baton Rouge, Louisiana, United States, 70808
- Recruiting
- Karl LeBlanc
-
Contact:
- Karl LeBlanc, MD
- Phone Number: 225-769-5656
- Email: karl.leblanc@fmolhs.org
-
Contact:
- Danielle Cobb, MD
- Phone Number: 225-769-5656
- Email: Danielle.Cobb@fmolhs.org
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- 18 years of age or older
- Have a ventral or inguinal hernia requiring surgical repair
Exclusion Criteria:
- Less than 18 years of age
- Chronic pain patients
- Having a defect >10 cm in transverse dimension
- Having a defect <4 cm
- Has an allergy to bupivacaine
- Has recurrent hernias as per medical history
- A TAP block performed at any time aside from just prior to the start of the procedure
- If bupivacaine is mixed with other anesthetics
- Under the instance of an emergency surgery (trauma)
- Concomitant surgery
- History of EtOH abuse
- History of liver/kidney dysfunction
- If the procedure must be converted to open
- Inidividual's weight < 50kg
- Individual's BMI > 45
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Liposomal Bupivacaine (Exparel)
The bilateral TAP block will be performed by the department of anesthesia under ultrasound guidance using 20cc of local anesthetic per side.
Additional local anesthetic will be supplied by the surgeon at the incision sites.
|
20cc of Liposomal Bupivacaine for TAP block
|
Active Comparator: Bupivacaine (Marcaine)
The bilateral TAP block will be performed by the department of anesthesia under ultrasound guidance using 20cc of local anesthetic per side.
Additional local anesthetic will be supplied by the surgeon at the incision sites.
|
20cc of Bupivacaine for TAP block
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Subjective Pain Scores using Visual Analog Scale (VAS)
Time Frame: For 1 week post-operation
|
Lower mean daily post-operative pain scores between participants in the Exparel vs. Bupivacaine arms recorded multiple times over the observation period.
The pain scale is 0-10 with 0 being no pain to 10 being the worst pain possible.
|
For 1 week post-operation
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Opioids Used Post-Operatively compared in anesthesia arms
Time Frame: For 1 Week post-operation
|
The amount of opioid pills taken, as measured by morphine equivalents, is reduced depending on the type of anesthetic used during the TAP block.
We will be measuring the post operative opioid usage by asking the patients how many narcotic pills they take daily after surgery for one week.
Variability comes into play if we prescribe different doses of Norco or if we use Percocet, therefore we will standardize this by converting these differing dosages in to morphine equivalents for both groups.
|
For 1 Week post-operation
|
Opioids Used Post-Operatively related to Hernia Size and Surgical Time
Time Frame: After 1 week post-operation
|
A decrease in the total number of opioid pills taken post-operatively compared to the total surgical time and how large the hernia defect is.
Increased surgical times and larger hernias may play a role in the amount of pain medication an individual may need post-operatively.
|
After 1 week post-operation
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Study Director: Leslie Son, PhD, Our lady of the Lake Hospital
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
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
- Pathologic Processes
- Postoperative Complications
- Pain
- Neurologic Manifestations
- Pathological Conditions, Anatomical
- Hernia, Abdominal
- Pain, Postoperative
- Hernia
- Hernia, Inguinal
- Hernia, Ventral
- Physiological Effects of Drugs
- Central Nervous System Depressants
- Peripheral Nervous System Agents
- Sensory System Agents
- Anesthetics
- Anesthetics, Local
- Bupivacaine
Other Study ID Numbers
- Anesthesia_Hernia_Pain
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
product manufactured in and exported from the U.S.
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.
Clinical Trials on Inguinal Hernia
-
Children's Mercy Hospital Kansas CityRecruitingInguinal Hernia | Inguinal Hernia, Indirect | Inguinal Hernia Unilateral | Inguinal Hernia BilateralUnited States
-
Hospital General Universitario ElcheCompletedInguinal Hernia | Inguinal Hernia Repair | Open Inguinal Hernia
-
San Bonifacio HospitalCompletedIndirect Inguinal Hernia | Direct Inguinal HerniaItaly
-
Bakirkoy Dr. Sadi Konuk Research and Training HospitalEnrolling by invitationInguinal Hernia | Strangulated Inguinal Hernia | Incarcerated Inguinal HerniaTurkey
-
University Hospital, GhentMedriCompleted
-
Ahmadullah DanishCompletedIncarcerated Inguinal HerniaAfghanistan
-
General Hospital of LarissaUnknown
-
Alexandria UniversityCompletedBilateral Inguinal Hernia
-
Hospital Siberia-SerenaUnknownPrimary Inguinal HerniaSpain
-
Diskapi Teaching and Research HospitalCompleted
Clinical Trials on Liposomal Bupivacaine
-
Yongtao SunNot yet recruitingPostoperative Analgesia | Thoracic Paravertebral Block | Thoracoscopic LobectomyChina
-
Steven OrebaughPacira Pharmaceuticals, IncCompleted
-
Indiana UniversityCompletedPain, Postoperative | Acute Pain | ThoracicUnited States
-
Vanderbilt University Medical CenterCompletedAnesthesia | Breast Reconstruction | Transverse Abdominis Plane BlockUnited States
-
University of MinnesotaCompleted
-
Indiana UniversityCompleted
-
University of MinnesotaCompleted
-
The University of Hong KongRecruitingShoulder FracturesHong Kong
-
University of California, San FranciscoCompletedPostoperative Pain | Thoracic Diseases | Opioid UseUnited States
-
Mayo ClinicCompletedPain, Postoperative | Brachial Plexus BlockUnited States