Transversus Abdominis Plane Blocks With Abdominoplasty

Study Overview
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Brief Summary
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Comparing morphine consumption and recovery with two different TAP block techniques after abdominoplasty.

Detailed Description
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TAP blocks have the potential to become an important part of multi-modal analgesia after abdominal surgery (1,2). Originally Dr J McDonnell described a blind double pop technique, trough the triangle of Petit, with up to 48 hours of analgesia (3,4). Dr P Hebbard described an ultrasound based technique with a subcostal (for supra-umbilical analgesia) and an axillary mid-line injection (for sub-umbilical analgesia) in the TAP, with reported analgesia for up to 8 hours (5,6). Recently Dr J McDonnell presented data showing para vertebral spread (up to L5) of the (high dose, low concentration) local anaesthetic explaining the prolonged analgesic effect (7,8). In 2007 Dr Blanco described an ultrasound guided technique for the posterior inﬁltration as performed by McDonnell (9). Our limited observational comparison between both block techniques conﬁrms this difference. We decided to compare both techniques (the ultrasound guided single shot subcostal injection, the aTAP-group (Hebbard is from Australia) and the ultrasound guided posterior injection, the iTAP-group (McDonnell is from Ireland). We will use the same volume and concentration of local anesthetic and we will asses their analgesic efﬁcacy and improvement in quality of recovery.

Official Title
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Transversus Abdominis Plane Blocks in Patients Scheduled for an Abdominoplasty. A Prospective, Randomized, Double Blind, Comparison Between the Posterior Approach and Placebo.

Conditions
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Post Operative Pain

Intervention / Treatment
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* Drug: Ropivacaine 0.25%, 0.5 ml/kg
* Drug: Ropivacaine 0.25%, 0.5 ml/kg


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Eligible for abdominoplasty ASA 1-2 Fluent french/dutch/english Exclusion Criteria: History of allergy to local anaesthetics Chronic opioids abuse Pregnant patients

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: iTAP-group<br>Posterior approach for TAP: ultrasound guided bilateral needle insertion in the transversus abdominis plane, anterior to the quadratus lumborum muscle | Drug: Ropivacaine 0.25%, 0.5 ml/kg<br>* Posterior approach for TAP: ultrasound guided bilateral needle insertion in the transversus abdominis plane, anterior to the quadratus lumborum muscle<br>|
| Active Comparator: aTAP-group<br>Subcostal approach for TAP: US guided needle insertion in the transversus abdominis plane, lateral to rectus sheet | Drug: Ropivacaine 0.25%, 0.5 ml/kg<br>* Subcostal approach for TAP: US guided needle insertion in the transversus abdominis plane, lateral to rectus sheet<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Morphine consumption | Consumption measured by the use of the PCA pump | 48 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| VAS score |  | 48 hours | 
| Post operative nausea and vomiting |  | 48 hours | 
| Constipation |  | 48 hours | 
| Pruritus |  | 48 hours | 
| First time to get up |  | 48 hours | 
| First time to eat |  | 48 hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Transversus abdominis plane block, Ultrasound guided, Abdominoplasty