Transversus Abdominis Plane Block in Iliac Crest harvest-is it Beneficial?

Study Overview
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Brief Summary
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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
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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.

Official Title
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Transversus Abdominis Plane Block Supplementation During Iliac Crest Bone Graft Harvest - Its Influence on Postoperative Parameters

Conditions
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Pain, Postoperative

Intervention / Treatment
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* Procedure: local infiltration and TAP block
* Procedure: local infiltration only


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Must undergo alveolar bone grafting as a part of the reconstructive procedure for cleft lip and palate Exclusion Criteria: Revision procedure History of difficulty in mentation and communication Bleeding disorders, hepatic problems or renal dysfunction Allergy to local anaesthetic Presence of infection of anterior abdominal wall

Ages Eligible for Study
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Minimum Age: 4 Years
Maximum Age: 22 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Local Infiltration with TAP block<br>Ultrasound guided Transversus Abdominis Plane block is administered intraoperatively using 0.2% Ropivacaine. | Procedure: local infiltration and TAP block<br>* Local infiltration of the iliac crest harvest site along with TAP block using 0.2 % Ropivacaine is done<br>|
| Experimental: Local Infiltration only<br>Local Infiltration with 0.2% Ropivacaine. | Procedure: local infiltration only<br>* Only local infiltration with 0.2% Ropivacaine of the iliac crest harvest site is done.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mean pain scores | Mean pain scores were assessed using the FLACC Behavioural Pain Assessment Scale, | First hour after extubation | 
| Emergence delirium | Emergence delirium was assessed using WATCHA Scale during the first hour after extubation | First hour after extubation | 
| Pain scores | Pain scores using the five - point verbal ranking score 24 hours after surgery | 24 hours after surgery | 
| Ambulatory status | Ambulatory status was assessed using one - day Cumulated Ambulatory Score 24 hours after surgery | 24 hours after surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Infection and delayed healing at the graft harvest site | All patients were interviewed for the presence of infection or delayed healing at the graft harvest site 6 weeks after surgery. | 6 weeks after surgery | 
| Chronic pain, numbness or discomfort at graft harvest site | All the patients were reviewed 12 weeks after surgery for the presence of chronic pain, numbness or discomfort at iliac crest harvest | 12 weeks after the surgery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Alveolar bone grafting, delirium, early ambulation