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CompletedNCT02007096Updated Jan 19, 2018Results posted

Does a Transabdominal Plane Block Decrease Patient Pain After Ventral Hernia Repair?

A Phase 2 interventional study of Transabdominal Plane Block and Non Transabdominal Plane Block in Ventral Hernia, Umbilical Hernia and Incisional Hernia, sponsored by Icahn School of Medicine at Mount Sinai. Completed at 1 site in United States. Open to participants aged 18 Years and older, including healthy volunteers. Per ClinicalTrials.gov, last updated 2018-01-19.

Sponsored by Icahn School of Medicine at Mount Sinai · Phase 2, Interventional, and Supportive care

Phase
Phase 2
Study type
Interventional
Enrollment
127
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

The purpose of this study is to determine if a Transabdominal Plane Block will decrease patient pain and pain medication use after a laparoscopic ventral (ventral, umbilical, incisional) hernia repair with mesh.

Read the detailed description

Patients coming in for a laparoscopic ventral (ventral, umbilical, incisional) hernia repair with mesh are randomized to either receive a Transabdominal Plane Block injection or a placebo saline injection. The injection will be performed by surgeons under direct visualization during laparoscopic surgery prior to mesh placement. Patients will be followed up post-operatively and after hospital discharge to assess for opioid usage and pain score. Patients in both arms are medically cleared by the surgeon. Currently there are no studies that look at the use of Transabdominal Plane Block in ventral hernia repairs.

02

Conditions studied

  • Ventral Hernia
  • Umbilical Hernia
  • Incisional Hernia
  • Postoperative Complications
  • Pain, Postoperative

Keywords

  • Transabdominal plane block
  • ventral hernia
  • umbilical hernia
  • incisional hernia
  • hernia repair
03

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
Yes

Inclusion criteria

  • age 18 and older
  • elective laparoscopic ventral (ventral, umbilical, incisional) hernia repair at Mount Sinai Hospital

Exclusion criteria

Exclusion Criteria:

  • age younger than 18
  • allergic reaction to bupivacaine
  • allergic reaction to opioids
  • opioid substance abuse
04

Study design

Phase
Phase 2
Primary purpose
Supportive care
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Double (Participant, Outcomes assessor)
Enrollment
127 participants (actual)

Study arms

  • Experimental
    Transabdominal Plane Block

    Receiving Transabdominal Plane Block with 0.25% bupivacaine

    Drug: Transabdominal Plane Block

  • Placebo comparator
    Non Transabdominal Plane Block

    Receiving placebo saline injection

    Drug: Non Transabdominal Plane Block

Interventions

  • DrugTransabdominal Plane Block

    0.25% bupivacaine injection in 6 different locations in abdomen. Weight \<100kg: 50ml total; weight \>100kg: 60ml total

    Also known as: Bupivacaine

  • DrugNon Transabdominal Plane Block

    Saline injection in 6 different locations in abdomen. Weight \<100kg: 50ml; weight \>100kg: 60ml

    Also known as: Saline

05

What researchers measure

Primary outcomes

  1. Post-operative Opioid Use

    Amount of opioids used by patients at certain time points.

    Time frame: up to 24 hours

Secondary outcomes

  1. Pain Score

    Post-operative Patient Self-Reported Pain Score. Patient self-reported pain scores when resting and when actively moving. Scale of 0 to 10, with 0 being "no pain" and 10 being "the most pain you have ever experienced."

    Time frame: 1 hour postoperatively

  2. Operating Procedure Time

    Total number of minutes for the procedure, not including anesthesia time.

    Time frame: Procedure begin time to procedure end time

  3. Pain Score

    Post-operative Patient Self-Reported Pain Score. Patient self-reported pain scores when resting and when actively moving. Scale of 0 to 10, with 0 being "no pain" and 10 being "the most pain you have ever experienced."

    Time frame: 24 hours postoperatively

06

Results

Posted Jan 19, 2018
Limitations and caveats
The surgeon knew the group assignment to administer the correct injection. Data not collected on clinical difference, e.g. postop nausea \& vomiting. Study conducted at one center with experienced surgeons, so the results might not be generalizable.

Participant flow

Participants recruited from the Department of Surgery at The Mount Sinai Hospital between November 2012 and October 2014.

Participant flow — Overall Study
MilestoneTransabdominal Plane BlockNon Transabdominal Plane Block
Started6364
Completed5248
Not completed1116
Withdrew: Medication not available20
Withdrew: Did not inject saline03
Withdrew: Did not follow postoperative protocol811
Withdrew: Converted to open surgery11
Withdrew: No mesh placed01

Outcome measures

PrimaryPost-operative Opioid Use

Amount of opioids used by patients at certain time points.

Time frame:
up to 24 hours
Reported as:
Mean · mg
Post-operative Opioid Use
mgTransabdominal Plane BlockNon Transabdominal Plane Block
at 6 hours10.59 ± 015.62 ± 0
at 12 hours16.09 ± 032.24 ± 0
at 18 hours20.70 ± 039.37 ± 0
at 24 hours25.64 ± 042.56 ± 0
SecondaryPain Score

Post-operative Patient Self-Reported Pain Score. Patient self-reported pain scores when resting and when actively moving. Scale of 0 to 10, with 0 being "no pain" and 10 being "the most pain you have ever experienced."

Time frame:
1 hour postoperatively
Reported as:
Mean · units on a scale
Pain Score
units on a scaleTransabdominal Plane BlockNon Transabdominal Plane Block
pain scores at rest5.19 ± 0.396.46 ± 0.38
pain scores with movement6.15 ± 0.427.73 ± 0.40
SecondaryOperating Procedure Time

Total number of minutes for the procedure, not including anesthesia time.

Time frame:
Procedure begin time to procedure end time
Reported as:
Mean · min
Operating Procedure Time
minTransabdominal Plane BlockNon Transabdominal Plane Block
Operating Procedure Time97.41 ± 30.2298.81 ± 37.51
SecondaryPain Score

Post-operative Patient Self-Reported Pain Score. Patient self-reported pain scores when resting and when actively moving. Scale of 0 to 10, with 0 being "no pain" and 10 being "the most pain you have ever experienced."

Time frame:
24 hours postoperatively
Reported as:
Mean · units on a scale
Pain Score
units on a scaleTransabdominal Plane BlockNon Transabdominal Plane Block
pain scores at rest4.60 ± 0.394.52 ± 0.31
pain scores with movement6.75 ± 0.386.98 ± 0.40

Adverse events

Non-serious events are listed at a 0% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Transabdominal Plane Block———
Non Transabdominal Plane Block———

Baseline characteristics

Age, Continuous
Age, Continuous(years)Transabdominal Plane BlockNon Transabdominal Plane BlockTotal
Mean52.67 ± 12.8953.81 ± 13.4553.22 ± 13.11
Sex: Female, Male
Sex: Female, Male(Participants)Transabdominal Plane BlockNon Transabdominal Plane BlockTotal
Female272148
Male252752
BMI
BMI(kg/m^2)Transabdominal Plane BlockNon Transabdominal Plane BlockTotal
Mean30.91 ± 5.4531.16 ± 7.0031.03 ± 6.21
ASA class
ASA class(Participants)Transabdominal Plane BlockNon Transabdominal Plane BlockTotal
17613
2242448
3201636
4123
Hypertension
Hypertension(Participants)Transabdominal Plane BlockNon Transabdominal Plane BlockTotal
Count of participants252348
Diabetes
Diabetes(Participants)Transabdominal Plane BlockNon Transabdominal Plane BlockTotal
Count of participants10919
Hyperlipidemia
Hyperlipidemia(Participants)Transabdominal Plane BlockNon Transabdominal Plane BlockTotal
Count of participants142034
Coronary artery disease
Coronary artery disease(Participants)Transabdominal Plane BlockNon Transabdominal Plane BlockTotal
Count of participants6915

6 further baseline measures are reported on the registry.

07

Study locations

1 site
  • Icahn School of Medicine at Mount Sinai
    New York, New York 10029, United States
08

References and documents

Publications

  • Fields AC, Gonzalez DO, Chin EH, Nguyen SQ, Zhang LP, Divino CM. Laparoscopic-Assisted Transversus Abdominis Plane Block for Postoperative Pain Control in Laparoscopic Ventral Hernia Repair: A Randomized Controlled Trial. J Am Coll Surg. 2015 Aug;221(2):462-9. doi: 10.1016/j.jamcollsurg.2015.04.007. Epub 2015 Apr 22. PubMed 26206644 ↗
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Registry details

Key details

Study ID
NCT02007096
Lead sponsor
Icahn School of Medicine at Mount Sinai
Responsible party
Celia M. Divino (Professor, Icahn School of Medicine at Mount Sinai) — Principal investigator
First posted
Dec 10, 2013
Start date
Aug 2012
Primary completion
Oct 2014
Completion
Oct 2014
Results posted
Jan 19, 2018
Last update
Jan 19, 2018

Study contacts

Celia M Divino, MD, FACS
principal investigator · Icahn School of Medicine at Mount Sinai

Oversight

Data monitoring committee
Yes
View the source record on ClinicalTrials.gov ↗

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