Postoperative Analgesia in Laparoscopic Abdominal Surgery After Exparel Via TAP or Local Infiltration

Study Overview
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Brief Summary
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This study evaluates differences in how administering liposomal bupivacaine via two different methods affects postoperative pain control in laparoscopic abdominal surgery patients. Half the participants will receive liposomal bupivacaine via a transverses abdominis plane block while the other half will receive liposomal bupivacaine via local infiltration.

Detailed Description
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Liposomal bupivacaine is a newer formulation of a local anesthetic that is commonly used for local infiltration, peripheral nerve blocks, and neuraxial anesthesia. This new formulation allows the effects of bupivacaine to last up to 72 hours as it is slowly released from a liposome. It is FDA approved for local infiltration and has recently been approved for interscalene blocks. A transversus abdominis plane block is a fascial plane block that is performed routinely for postoperative pain relief for some abdominal incisions. It is performed by placing local anesthetic between the internal oblique and transverses abdominis muscle planes where it will provide analgesia to several dermatomes of the abdomen in hopes of improving postoperative pain relief and reducing postoperative opioid requirement.

Official Title
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On Postoperative Analgesic Requirements in Laparoscopic Colorectal Surgery Patients After Exparel Administration Via Transversus Abdominis Plane Block Versus Surgical Infiltration

Conditions
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Pain, Postoperative, Anesthesia, Local, Anesthesia; Functional, Anesthesia, Opioid Use

Intervention / Treatment
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* Drug: Exparel 266 MG Per 20 ML Injection


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients scheduled for elective laparoscopic colorectal surgery at UWMC requiring inpatient stay Exclusion Criteria: Patients on chronic pain mediations equaling or exceeding > 25 morphine daily equivalents Patients allergic to bupivacaine Patients with ASA status IV, V, or VI Patients unable to consent Patients that are pregnant Patients that are incarcerated Patients receiving procedures in addition to laparoscopic colorectal procedure Patients on systemic anticoagulation precluding them from regional blocks

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

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: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Unblinded randomized trial
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Local infiltration<br>Liposomal bupivacaine (266mg) will be directly infiltrated by the surgeon into the surgical laparoscopic wound sites. | Drug: Exparel 266 MG Per 20 ML Injection<br>* Liposomal bupivacaine<br>|
| Experimental: Transversus abdominis plane block<br>Liposomal bupivacaine (266mg) will be used in a ultrasound guided transversus abdominis plane block. | Drug: Exparel 266 MG Per 20 ML Injection<br>* Liposomal bupivacaine<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 24 hour post operative opioid consumption | Listed in morphine daily equivalents. | 24 hours postoperative | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 12 hour post operative opioid consumption | Listed in morphine daily equivalents | 12 hours postoperative | 
| 48 hour post operative opioid consumption | Listed in morphine daily equivalents | 48 hours postoperative | 
| Pain intensity at 12 hours post operative | Self reported pain intensity by visual analog scale scored 0-10 (0 = no pain; 10 = worst pain imaginable) | 12 hours | 
| Pain intensity at 24 hours post operative | Self reported pain intensity by visual analog scale scored 0-10 (0 = no pain; 10 = worst pain imaginable) | 24 hours | 
| Hospital length of stay | How long the patient requires their inpatient stay measured in days. | Until end of hospital stay, typically 3 days |