Transversus Abdominis Plane Block Versus Local Anesthetic Infiltration for Pain Control in the Abdominal Surgery

Not Applicable

Completed

Conditions: Postoperative Pain

Interventions: Procedure: Patient controlled analgesia
Procedure: transversus abdominis plane block
Procedure: local infiltration

Registration Number: NCT02029755

Lead Sponsor: Taipei Medical University Hospital

Brief Summary: Postoperative analgesia is an important part of the anesthetic care. According to the recent studies, multimodal analgesia can provide better analgesia \& patient satisfaction with fewer side effect. For example, combining intravenous, intramuscular or oral analgesics with transversus abdominis plane (TAP) block or local anesthetic (LA) infiltration as the multimodal analgesia, can furnish a more effective pain control after the abdominal surgery.

For abdominal surgery, both local infiltration and TAP block target on relieving somatic pain. Local anesthetic wound infiltration is easy to perform with low risk. As the advancement of ultrasound technology, performing the TAP block also becomes easier, safer and more accurate. But whether LA infiltration or TAP block is better for the multimodal analgesia regimen remains unclear.

This study is to compare the postoperative pain score, opioid consumption, side effects, and quality of recovery between these two analgesic methods in patients undergoing abdominal surgery. The investigators hypothesized that TAP block may be more effective than LA infiltration as a part of the multimodal analgesia, and can improve the recovery after the abdominal surgery.

Detailed Description: Not available

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 108

Inclusion Criteria

Adult (20~65y/o)
American Society of Anesthesiologists (ASA) physical status I~II
Patients scheduled for regular abdominal surgery under general anesthesia

Exclusion Criteria

ASA physical status ≥ 3
Allergy to morphine or local anesthetics
Morphine tolerance
Drug abuse or addiction
Bleeding tendency

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
PCA only	Patient controlled analgesia	postoperative analgesia with intravenous patient controlled analgesia. IV-PCA with morphine will be ready for postoperative pain control at the end of the surgery.
TAP block	transversus abdominis plane block	postoperative analgesia with sono-guided transversus abdominis plane block and intravenous patient controlled analgesia (IV-PCA). Bilateral sono-guided TAP block will be performed after the induction of general anesthesia. 20 ml of 0.25% ropivacaine will be injected to the transversus abdominis plane under ultrasound guidance at each side (total 40 ml). IV-PCA with morphine will be ready for postoperative pain control at the end of the surgery.
TAP block	Patient controlled analgesia	postoperative analgesia with sono-guided transversus abdominis plane block and intravenous patient controlled analgesia (IV-PCA). Bilateral sono-guided TAP block will be performed after the induction of general anesthesia. 20 ml of 0.25% ropivacaine will be injected to the transversus abdominis plane under ultrasound guidance at each side (total 40 ml). IV-PCA with morphine will be ready for postoperative pain control at the end of the surgery.
Local infiltration	local infiltration	postoperative analgesia with local anesthetics infiltration at surgical wound and intravenous patient controlled analgesia (IV-PCA). 20 ml of 0.5% ropivacaine will be injected at the surgical wound by the surgeon before the closure of wound. IV-PCA with morphine will be ready for postoperative pain control at the end of the surgery.
Local infiltration	Patient controlled analgesia	postoperative analgesia with local anesthetics infiltration at surgical wound and intravenous patient controlled analgesia (IV-PCA). 20 ml of 0.5% ropivacaine will be injected at the surgical wound by the surgeon before the closure of wound. IV-PCA with morphine will be ready for postoperative pain control at the end of the surgery.

Primary Outcome Measures

Name	Time	Method
Opioid Consumption	postoperative 48 hour	opioid consumption of the participants will be followed at postoperative 1, 6, 12, 24, 36, 48 hour (up to 48 hours).
Pain Score (NRS: Numerical Rating Scale)	postoperative 24 hour dynamic	pain scores of the participants will be followed at postoperative 1, 6, 24, 48 hour (up to 48 hours). (NRS: from 0 to 10, 0 = no pain, 10 = the worst pain) The higher score idicates the worse outcome.

Secondary Outcome Measures

Name	Time	Method
Sedation Scale	postoperative 1, 6, 24, 48 hour
Nausea and Vomiting Categorical Score	postoperative 1, 6, 24, 48 hour
Rescue Antiemetics Use	postoperative 1, 6, 12, 24, 36, 48 hour
Time to the First Request of Analgesics	an expected average of 5 days	participants will be followed for the duration of hospital stay
Heart Rate Variability	preoperative, postoperative 1 hour and 1 day
Length of Hospital Stay	an expected average of 5 days	participants will be followed for the duration of hospital stay
Rescue Analgesic Use	postoperative 1, 6, 12, 24, 36, 48 hour
Time to Flatus	an expected average of 5 days	participants will be followed for the duration of hospital stay
Quality of Recovery 40	postoperative 48 hour
Pruritus	postoperative 1, 6, 24, 48 hour
Number of Participants With Intervention-related Complication	an expected average of 5 days	participants will be followed for the duration of hospital stay