Clinical trial NCT01740193: Comparison of Two Different Pain Management Techniques in Pediatric Patients Undergoing a Hernia Repair
Official title: Randomized Prospective Comparison of Analgesic Efficacy of Surgeon Performed IIlioinguinal/Iliohypogastric Blockade With Ultrasound-Guided TAP Blockade in Pediatric Patients Undergoing Unilateral Herniorrhaphy on an Outpatient Basis
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Pain
Inguinal Hernia
Keywords: Pain
Regional Anesthesia
ultrasound
transversus abdominis plane
herniorrhaphy
pediatrics
Lead sponsor: Children's Hospital Medical Center, Cincinnati
Sponsor class: OTHER
First posted: 2012-12-04
Enrollment: 59
Sex: ALL
Minimum age (years): 12
Maximum age (years): 10
Standard ages: CHILD
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The purpose of this research study is to find the best way to decrease pain in children right after surgery whom have had their hernia fixed. Right now, there are two different ways surgeons and anesthesia providers try to decrease pain. It is not clear if one way is better than the other. The method used is often chosen by which one the doctor has more experience using. The Investigator plans to find out if one of the methods is more effective and/or safer than the other method.

The results of this study will help learn how to best control pain in children having surgery for hernia repair.

Detailed description: Unilateral inguinal herniorrhaphy is a commonly performed surgical procedure in the pediatric population. Multimodal anesthesia consisting of systemic narcotics, surgical wound infiltration with local anesthetic and ilioinguinal and/or iliohypogastric nerve blockade has traditionally been employed to achieve acceptable analgesia. Recently, ultrasound-based studies have demonstrated that blind abdominal wall injections are done with poor accuracy. Ultrasound-guided alternatives, such as the transverses abdominis plane (TAP) block, may improve analgesic efficacy and patient comfort in the post-operative period when compared to blind landmark based nerve blockade. There has been increasing utilization of the TAP block in the adult population due to the described ability to provide effective blockade of the thoracolumbar spinal nerves innervating the abdominal wall. We propose a randomized prospective evaluation of the analgesic efficacy comparing surgeon performed ilioinguinal/iliohypogastric block with ultrasound-guided TAP blockade in healthy ASA I and II pediatric patients undergoing unilateral herniorrhaphy on an outpatient basis.

Eligibility criteria: Inclusion Criteria:

* The subject is male or female;
* The subject is of any racial and ethnic groups;
* The subject is age 12 months to 10 years (inclusive);
* The subject weighs more than 8.0 kg (inclusive of the eighth kilogram);
* The subject is scheduled for the following: Unilateral herniorrhaphy scheduled on an out-patient basis, and not being performed in conjunction with any other surgical procedures;
* The subject is American Society of Anesthesiologists (ASA) patient classification I-II
* The subject's legally authorized representative has given written informed consent to participate in the study and when appropriate, the subject has given assent or consent to participate.

Exclusion Criteria:

* Additional surgical procedures are being performed concurrently;
* The subject is ASA classification \> II;
* The subject has pre-existing allergies to local anesthetics;
* The subject receives midazolam as a premedication;
* The subject has an imminent life threatening condition that impacts the ability to obtain informed consent;
* The subject has any other condition, which in the opinion of the principal investigator, would not be suitable for participation in the study.

Primary outcomes:
measure: Efficacy Outcome
timeFrame: Participants will be followed for the duration of post-anesthesia care unit stay, an expected average of 2 hours
Secondary outcomes:
measure: Efficacy Outcome - Length of Recovery Room
timeFrame: participants will be followed for the length of the surgical procedure, an expected average of 1.5 hours
measure: Confounding Variable - Electrocautery
timeFrame: participants will be followed for the length of the surgical procedure, an expected average of 1.5 hours
measure: Confounding Variable - Surgical dissection
timeFrame: participants will be followed for the length of the surgical procedure, an expected average of 1.5 hours
measure: Confounding Variable - Length of time for TAP
timeFrame: participants will be followed for the length of the surgical procedure, an expected average of 1.5 hours
measure: Efficacy Outcome - Post-operative Calls
timeFrame: participants will be followed for 48 hours after procedure
measure: Outcome Measure - Number of patients with post-operative complications
timeFrame: participants will be followed for 48 hours after procedure
Other outcomes:
Locations:
city: Cincinnati
country: United States
facility: Cincinnati Children's Hosptial Medical Center - Liberty Campus
state: Ohio
Study officials:
affiliation: Children's Hospital Medical Center, Cincinnati
name: Jamie Furstein, CRNA, DNAP
role: PRINCIPAL_INVESTIGATOR
References:
citation: Niraj G, Searle A, Mathews M, Misra V, Baban M, Kiani S, Wong M. Analgesic efficacy of ultrasound-guided transversus abdominis plane block in patients undergoing open appendicectomy. Br J Anaesth. 2009 Oct;103(4):601-5. doi: 10.1093/bja/aep175. Epub 2009 Jun 26.
citation: Fredrickson M, Seal P, Houghton J. Early experience with the transversus abdominis plane block in children. Paediatr Anaesth. 2008 Sep;18(9):891-2. doi: 10.1111/j.1460-9592.2008.02591.x. No abstract available.
citation: Aveline C, Le Hetet H, Le Roux A, Vautier P, Cognet F, Vinet E, Tison C, Bonnet F. Comparison between ultrasound-guided transversus abdominis plane and conventional ilioinguinal/iliohypogastric nerve blocks for day-case open inguinal hernia repair. Br J Anaesth. 2011 Mar;106(3):380-6. doi: 10.1093/bja/aeq363. Epub 2010 Dec 21.
citation: Fredrickson MJ, Seal P. Ultrasound-guided transversus abdominis plane block for neonatal abdominal surgery. Anaesth Intensive Care. 2009 May;37(3):469-72. doi: 10.1177/0310057X0903700303.
citation: Groudine SB, Fisher HA, Kaufman RP Jr, Patel MK, Wilkins LJ, Mehta SA, Lumb PD. Intravenous lidocaine speeds the return of bowel function, decreases postoperative pain, and shortens hospital stay in patients undergoing radical retropubic prostatectomy. Anesth Analg. 1998 Feb;86(2):235-9. doi: 10.1097/00000539-199802000-00003.
citation: Hadzic A, New York School of Regional Anesthesia.: Textbook of regional anesthesia and acute pain management. New York: McGraw-Hill, Medical Pub. Division; 2007.