Transversus Abdominis Plane Block in Iliac Crest harvest-is it Beneficial?
Condition: Pain, Postoperative
MeSH terms: Pain, Postoperative
Study type: Interventional

Summary: 
      The purpose of this study is to determine whether a supplemental Transversus Abdominis Plane
      block administered intraoperatively improves the postoperative parameters in patients
      undergoing Alveolar bone grafting with iliac crest harvest. It also aims to find out if there
      is a decrease in the incidence of chronic pain or numbness at the harvest site.
    

Detailed description: 
      This study is a prospective, randomised, parallel group, single - centre trial evaluating the
      postoperative parameters in patients receiving supplemental Transversus Abdominis Plane block
      for anterior iliac crest harvest. It was conducted in 143 patients undergoing Alveolar bone
      grafting with iliac crest bone graft.

      Methodology:

      Informed consent and approval of local ethics and research committee in Jubilee Mission
      Medical College and Research Institute, Thrissur, India was obtained prior to initiation of
      the study. A pilot study was done to determine the efficacy of the additional TAP block. The
      results showed that the intervention improved patient analgesia and reduced the requirement
      for rescue analgesics. A minimum sample size of 65 patients was calculated for each group to
      obtain a power of 80% and confidence interval of 95%. 143 patients aged between 7 and 22
      years posted for Alveolar bone grafting with anterior iliac crest harvest were assessed in
      the study. Only those undergoing Alveolar bone grafting as a part of the reconstructive
      procedure for cleft lip and palate were considered for the study. The patients who had
      difficulty in mentation and communication,bleeding disorders, hepatic problems, infection of
      the abdominal wall, renal dysfunction as well as allergy to the local anaesthetic were
      excluded from the study. Patients undergoing revision surgeries were also excluded from the
      study. All the candidates were randomly alloted to either of the two groups, using a computer
      - generated number.

      All the patients were premedicated with Midazolam 0.15mg kg-1 and Glycopyrolate 0.01mg kg-1
      Anaesthesia was induced with Propofol 2 mg kg -1 and Fentanyl 2 mcg kg-1 .Vecuronium 0.1 mg
      kg-1 was given to facilitate orotracheal intubation with a cuffed tube.Anaesthesia was
      maintained with oxygen, nitrous oxide and sevoflurane. Prior to incision, all the patients
      were given wound infiltration with 0.75 ml kg-1 of 0.2% Ropivacaine at the graft harvest
      site. Those in group A received an additional ultrasound guided Transversus Abdominis Plane
      block with a similar volume and concentration of Ropivacaine.

      At the end of the surgical procedure, the patients were extubated awake, after giving I / V
      Neostigmine 0.05 mg kg-1. Just prior to extubation, I/V Tramadol 0.5 mg kg-1 was given for
      the pain in the postoperative period. In the recovery room, the pain and emergence delirium
      were assessed by an independent observer every ten minutes during the first postoperative
      hour.These were evaluated using the FLACC Behavioural Pain Assessment Scale and WATCHA Scale
      respectively. They were subsequently shifted to the postoperative ward.

      The next time point of assessment was 24 hours post - surgery, when the patient's pain and
      ambulatory status were evaluated. The pain was ranked using the five - point verbal ranking
      score. It was ranked as no pain, light pain, moderate pain, severe pain and intolerable pain,
      with a score of 0,1,2,3 and 4 respectively. The total number of rescue analgesics demanded by
      the patient on the first postoperative day was noted.Ambulatory status was graded using one -
      day Cumulated Ambulatory Score.

      The patients were followed up and questioned at six weeks and twelve weeks post operatively
      for the presence of chronic pain, numbness or wound healing problems at the harvest site.
    

Intervention name(s): local infiltration and TAP block; local infiltration only
Intervention type(s): Procedure; Procedure
Intervention description(s): Local infiltration of the iliac crest harvest site along with TAP block using 0.2 % Ropivacaine is done; Only local infiltration with 0.2% Ropivacaine of the iliac crest harvest site is done.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Alveolar bone grafting; delirium; early ambulation