TAP vs Surgical Infiltration of Local Anesthetic in Laparoscopic and Robotic Hysterectomy
Condition: Acute Pain
MeSH terms: Acute Pain
Intervention: Liposomal Bupivacaine; Bupivacaine; Ultrasound; Epinephrine; acetaminophen; ibuprofen; Oxycodone
Intervention description: In one arm the TAP infiltration will contain 10 mL of 0.25 % bupivacaine with epinephrine injected followed by 20 mL of a 50:50 mixture of liposomal bupivacaine and normal saline. This will then be repeated on the contralateral side.; Surgical Infiltration of the study solution will be performed both prior to incision and at the end of surgery just prior to closure of incisions. At each time, the surgeon will inject 5 mL of 0.25% bupivacaine into each of the port site incisions.; An ultrasound, which is a beam of high frequency sound that allows one to visualize images in the body, will be used to aid investigators to observe the local anesthetic being infiltrated into the plane; TAP infiltration will contain 10 mL of 0.25 % bupivacaine with epinephrine.; all individuals will receive scheduled acetaminophen (1 gram every 6 hours),; all individuals will receive scheduled ibuprofen (800 mg every 8 hours); all individuals will receive PRN oxycodone 5-10mg q4h if pain is rated at more than 5 out of 10 on a numerical pain scale.
Intervention MeSH terms: Acetaminophen; Ibuprofen; Epinephrine; Oxycodone; Bupivacaine
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Enrollment: 87.0
Sex: Female
Minimum age: 18 Years
Healthy volunteers: No

Summary:

      Laparoscopic and Robotic assisted hysterectomy is a surgical procedure that is a minimally
      invasive way in which to remove the uterus, which has less scarring and fewer complications.
      However, this procedure, much like its open-surgical counterpart, is often associated with
      significant post-operative pain. To augment this pain there are many different analgesic
      techniques available to offset pain. Ultrasound-guided transversus abdominis plane (TAP)
      block is one such procedure involving the injection of a local anesthetic into the plane of
      the transversus abdominal muscle where the terminal branches of nerves lie. A similar, yet
      different analgesic approach is that of direct injection of local anesthetic into the
      incision by the surgeon during or just after surgical procedures. These two approaches have
      both been proven to decrease post-operative pain in patients for many procedures, but never
      compared to one another.
    

Eligibility criteria:

        Inclusion Criteria:

          -  ASA physical status I-III

          -  Females >/=18-years of age

          -  Scheduled for laparoscopic/robot-assisted hysterectomy.

        Exclusion Criteria

          -  Contraindication to surgical infiltration or regional blockade

          -  History of long term opioid intake (greater than 3 weeks prior to surgery) or chronic
             pain disorder

          -  Inability to understand the informed consent and demands of the study

          -  Surgery scheduled to start after 1700