Laparoscopic Assisted Plane Block (LAPB) Trial
| Status: | Recruiting |
|---|---|
| Healthy: | No |
| Age Range: | 18 - 80 |
| Updated: | 4/6/2019 |
| Start Date: | February 4, 2019 |
| End Date: | January 2020 |
| Contact: | Jenni Nix, MD |
| Email: | j2nix@sbch.org |
| Phone: | 805-682-7111 |
Laparoscopic Assisted Plane Block (LAPB) Trial: Bupivacaine Versus Liposomal Bupivacaine Versus Standard Local Anesthesia for Post-operative Analgesia
This study attempts to demonstrate improvement in analgesia in a more diverse laparoscopic
surgery group with the use of laparoscopic assisted transversus abdominis plane blocks. The
investigators will compare bupivacaine (treatment arm 1) versus liposomal bupivacaine
(treatment arm 2) versus port site injection of local anesthesia with injection of saline
placebo (control). The hypothesis is that liposomal bupivacaine will result in improved
analgesia when compared to bupivacaine LAPB and control. The investigators further
hypothesize that bupivacaine LAPB will be more effective than the control.
surgery group with the use of laparoscopic assisted transversus abdominis plane blocks. The
investigators will compare bupivacaine (treatment arm 1) versus liposomal bupivacaine
(treatment arm 2) versus port site injection of local anesthesia with injection of saline
placebo (control). The hypothesis is that liposomal bupivacaine will result in improved
analgesia when compared to bupivacaine LAPB and control. The investigators further
hypothesize that bupivacaine LAPB will be more effective than the control.
Patients will either be pre-screened prior to their pre-operative appointment for
eligibility, or screening will occur on the day of surgery. Informed Consent will be obtained
from amenable, eligible patients prior to their operation by a member of the research team. A
study number will be assigned, and the patient will be randomized to a treatment group. The
patients will not be aware to which treatment group they have been randomized.
After consent is obtained and randomization has been completed, the operating room registered
nurse will calculate maximum dose of allowable bupivacaine per patient based on body weight.
Anesthesia will provide the intravenous lidocaine bolus on induction to all patients without
a contraindication to the medication. The port placement will occur using a needle to raise
skin/preperitoneal wheal*. Up to 20cc of 1% lidocaine/epinephrine will be divided among all
ports and stab incisions. At end of case, no further skin or port-specific preperitoneal
anesthetic will be injected unless a skin incision was extended.
For patients randomized to port site injection (Control): 60 cc of sterile,
preservative-free, injectable saline will be given as a placebo per the protocol in item 6.
For patients randomized to bupivacaine plain LAPB (Treatment Arm 1): The maximum weight-based
dose of plain bupivacaine will be diluted with sterile, injectable, preservative-free saline
to a total of 60cc with a maximum of 250mg bupivacaine (regardless of weight) and loaded into
a 30cc syringe with a 22g spinal needle (one 30cc syringe used for each side).
For patients randomized to liposomal bupivacaine LAPB (Treatment Arm 2): The maximum dose for
adult patients is 266mg (20mL) of liposomal bupivacaine. This will be diluted with 40cc of
preservative-free normal saline for injection, per manufacturer recommendations. The solution
will then be loaded into a 30cc syringe with a 22g spinal needle and injected in the same
fashion as the bupivacaine plain LAPB.
Data collection will include total doses of IV and skin and block anesthetic used, patient
weight, number and size of ports, if fascial closure of port site was conducted, and
post-operative narcotic medication used up to 48 hours with timing and doses marked, and use
of any pain adjuncts (nonsteroidal anti-inflammatory drugs [NSAIDs], acetaminophen,
gabapentin, tricyclic antidepressants [TCA], pregabalin, clonidine, etc.) although doses of
these medications are not to be recorded.
Provision of home narcotic prescription will be based on a standardized protocol developed by
Dartmouth. Based on the past 24 hours of pain medication usage, patients will receive either
15 or 30 tablets of hydrocodone/acetaminophen 5/325mg (or liquid equivalent for bariatric
patients). Use of narcotic medications at home will be evaluated at 1 week post-procedure by
a member of the research team through a phone survey.
eligibility, or screening will occur on the day of surgery. Informed Consent will be obtained
from amenable, eligible patients prior to their operation by a member of the research team. A
study number will be assigned, and the patient will be randomized to a treatment group. The
patients will not be aware to which treatment group they have been randomized.
After consent is obtained and randomization has been completed, the operating room registered
nurse will calculate maximum dose of allowable bupivacaine per patient based on body weight.
Anesthesia will provide the intravenous lidocaine bolus on induction to all patients without
a contraindication to the medication. The port placement will occur using a needle to raise
skin/preperitoneal wheal*. Up to 20cc of 1% lidocaine/epinephrine will be divided among all
ports and stab incisions. At end of case, no further skin or port-specific preperitoneal
anesthetic will be injected unless a skin incision was extended.
For patients randomized to port site injection (Control): 60 cc of sterile,
preservative-free, injectable saline will be given as a placebo per the protocol in item 6.
For patients randomized to bupivacaine plain LAPB (Treatment Arm 1): The maximum weight-based
dose of plain bupivacaine will be diluted with sterile, injectable, preservative-free saline
to a total of 60cc with a maximum of 250mg bupivacaine (regardless of weight) and loaded into
a 30cc syringe with a 22g spinal needle (one 30cc syringe used for each side).
For patients randomized to liposomal bupivacaine LAPB (Treatment Arm 2): The maximum dose for
adult patients is 266mg (20mL) of liposomal bupivacaine. This will be diluted with 40cc of
preservative-free normal saline for injection, per manufacturer recommendations. The solution
will then be loaded into a 30cc syringe with a 22g spinal needle and injected in the same
fashion as the bupivacaine plain LAPB.
Data collection will include total doses of IV and skin and block anesthetic used, patient
weight, number and size of ports, if fascial closure of port site was conducted, and
post-operative narcotic medication used up to 48 hours with timing and doses marked, and use
of any pain adjuncts (nonsteroidal anti-inflammatory drugs [NSAIDs], acetaminophen,
gabapentin, tricyclic antidepressants [TCA], pregabalin, clonidine, etc.) although doses of
these medications are not to be recorded.
Provision of home narcotic prescription will be based on a standardized protocol developed by
Dartmouth. Based on the past 24 hours of pain medication usage, patients will receive either
15 or 30 tablets of hydrocodone/acetaminophen 5/325mg (or liquid equivalent for bariatric
patients). Use of narcotic medications at home will be evaluated at 1 week post-procedure by
a member of the research team through a phone survey.
Inclusion Criteria:
- Patients aged 18-80 years old
- Patients undergoing non-emergent laparoscopic surgery with planned or continued
admission for at least 1 night
- Patients who receive fully laparoscopic procedures including ports up to 15mm, and any
blunt dilation of port fascia or sharp extension of skin incisions for specimen
extraction.
Exclusion Criteria:
- Patients under 18 or over 80 years old
- Patients who are pregnant
- Patients who are unable to consent themselves
- Patients who undergo an appendectomy for acute appendicitis
- Patients who undergo emergent surgery
- Patients who are converted to open procedure
- Patients who receive concurrent neuraxial anesthesia (spinal, epidural, or indwelling
pain pumps)
- Patients who receive concurrent local anesthetic drips planned during or administered
immediately after surgery
- Patients who have a contraindication to local anesthetics (e.g. verified allergy,
severe hepatic dysfunction)
- Patients who use chronic narcotics
We found this trial at
1
site
Click here to add this to my saved trials
