Intraoperative TAP Block With Bupivacaine/Dexamethasone Against Liposomal Bupivacaine (Exparel®)
Condition: Pain, Postoperative; Crohn Disease; Inflammatory Bowel Diseases; Colorectal Cancer; Gastrointestinal Cancer; Gastrointestinal Disease; Digestive System Disease; Pain; Pain, Neuropathic; Intestinal Disease
MeSH terms: Gastrointestinal Neoplasms; Crohn Disease; Intestinal Diseases; Inflammatory Bowel Diseases; Gastrointestinal Diseases; Digestive System Diseases; Neuralgia; Pain, Postoperative
Intervention: Liposomal bupivacaine; Bupivacaine/epinephrine/dexamethasone
Intervention description: Liposomal bupivacaine will be given during the bilateral laparoscopic-guided TAP block given to each patient intraoperatively.; Bupivacaine/epinephrine/dexamethasone will be given during the bilateral laparoscopic-guided TAP block administered to each patient intraoperatively.
Intervention MeSH terms: Dexamethasone; Epinephrine; Bupivacaine
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Enrollment: 102.0
Sex: All
Minimum age: 18 Years
Maximum age: 90 Years
Healthy volunteers: No
Keywords: transversus abdominis plane block; tap block; liposomal bupivacaine; exparel; dexamethasone; colorectal surgery; regional anesthesia; bupivacaine; surgery; postoperative pain; pain

Summary:

      Traditionally, opioids are heavily utilized in treating postoperative pain but they are
      associated with numerous side effects. The use of the transversus abdominis plane (TAP)
      blocks have become standard practice to extend the post-operative analgesic window and limit
      opioid use. A new liposomal-depo formulation of bupivacaine (Exparel) has gained popularity
      as a long-lasting TAP block medication, but has not been studied in a well-powered clinical
      trial specifically in colorectal patients nor compared to a bupivacaine/steroid mixture which
      may offer similar effects. We conduct a prospective randomized prospective randomized study
      of patients undergoing major laparoscopic colorectal surgery to compare the analgesic effects
      of a bupivacaine/steroid mixture versus liposomal bupivacaine.
    

Eligibility criteria:

        Inclusion Criteria:

          1. Male or Female

          2. Undergoing major laparoscopic colorectal procedure

          3. Willingness and ability to sign an informed consent document

          4. No allergies to anesthetic or analgesic medications

          5. ASA physical status Class I - III

          6. Aged 18-90 years

        Exclusion Criteria:

          1. Refusal to participate in the study

          2. Age <18 or > 90 years

          3. Pregnancy

          4. Contraindications to regional anesthetic including but not limited to:

               1. Patient refusal to regional field blockade

               2. Allergy

               3. Infection at the site of needle insertion

               4. Systemic infection

               5. Bleeding diathesis or coagulopathy (as diagnosed by history or laboratory
                  evaluation)

               6. Liver or renal disease (SCr > 1.5)

          5. Chronic opioid use