Transversus Abdominis Plane Block in Children Undergoing Ostomy Surgery

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01136668
Recruitment Status : Terminated (Unable to recruit adequate number of subjects)
First Posted : June 3, 2010
Last Update Posted : April 18, 2016
Information provided by (Responsible Party):
Jason Hayes, The Hospital for Sick Children

Brief Summary:
The primary objective of this study is to determine if the use of Transversus Abdominis Plane (TAP) blocks reduce early postoperative opioid requirements.

Condition or disease Intervention/treatment Phase
Anesthesia Ostomy Procedure: Transversus Abdominis Plane Block Procedure: Standard Phase 2

Detailed Description:

Revision or closure of ostomy is a common elective surgical procedure at The Hospital for Sick Children. A retrospective audit conducted at SickKids demonstrated significant intraoperative opioid use and significant requirements for rescue opioids in recovery.

Concerns exist regarding the relative merits of opioid use in abdominal surgery. Opioids may decrease bowel motility leading to the increased incidence and duration of postoperative ileus. They may be associated with increased rates of post-operative nausea and vomiting and pruritus. Lastly children may under-report their pain or pain may not be recognized by medical staff leading to inadequate provision of analgesia. This suggests that the use of a regional technique may benefit children undergoing revision of ostomy.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 9 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Transversus Abdominis Plane Block in Children Undergoing Ostomy Surgery: A Prospective Randomized Controlled Trial
Study Start Date : April 2010
Actual Primary Completion Date : May 2012
Actual Study Completion Date : May 2012

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Ostomy

Arm Intervention/treatment
Experimental: Treatment group Procedure: Transversus Abdominis Plane Block
A high frequency (5-10 mHz) ultrasound probe (Sonosite Micromaxx, Licence No 12407) will be placed on the flank at the midpoint between the iliac crest and lower costal margin. The three muscle layers of external oblique, internal oblique, and transversus abdominis will be visualized. A 22G short-bevel block needle will be advanced in an anterior-to-posterior direction, in-plane with the probe, until the tip is visualized in the transversus abdominis plane. After negative aspiration, 0.4 ml/kg of bupivacaine 0.25% with 1:200,000 epinephrine will be injected. The total dose of bupivacaine will not exceed 2 mg/kg and the total volume will not be more than 20 ml.

Active Comparator: Control Group Procedure: Standard
Circumferential subcutaneous infiltration of the ostomy wound with bupivacaine 0.25% with 1:200 000 epinephrine 0.4 ml/kg by the surgeon after skin closure.

Primary Outcome Measures :
  1. Morphine Requirement [ Time Frame: within the first 48 hours after surgery ]
    The primary endpoint will be the proportion of children in each group requiring two or more (≥ 2) boluses of morphine in the PACU.

Secondary Outcome Measures :
  1. Dose of opioids administered [ Time Frame: within the first 48 hours after surgery ]
  2. Pain scores [ Time Frame: within the first 48 hours after surgery ]
    Pain scores will be assessed using the Faces-Legs-Activity-Cry-Consolibility (FLACC) scale for children ≤ 7 years old (Appendix 2 of Protocol) and the Numerical Rating Scale (NRS) for children > 7 years old. Pain scores will be determined by agreement between the PACU nurse and Anesthesia Clinical Research Nurse, both of whom will be blinded to the group allocation. Pain scores will be assessed at admission (time=0), 5, 10, 15, 30, and then every 15 minutes thereafter until discharge from PACU.

  3. Incidence of opioid-related side effects [ Time Frame: within the first 48 hours after surgery ]
    A study investigator or research nurse will assess the patient (from both groups to maintain blinding) each day during the hospital admission for signs of adverse events related to the TAP block, such as persistent pain or redness, swelling, and/or discharge from the puncture site.

  4. Time to tolerance of oral intake [ Time Frame: within the first 48 hours after surgery ]

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Ages Eligible for Study:   3 Months to 18 Years   (Child, Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • children undergoing revision or closure of ostomy
  • American Society of Anesthesiologists Classification 1-3.
  • age ≥ 3 months

Exclusion Criteria:

  • children undergoing an additional surgical procedure (e.g. circumcision) at an anatomical location not covered by a one-sided/ unilateral TAP block, during the same anesthetic
  • children in whom a TAP block is contraindicated, i.e. surgical scar or distorted anatomy at the site of injection
  • postoperative admission to the intensive care unit
  • children with a known allergy to bupivacaine
  • children with a history of chronic abdominal pain
  • use of opioid analgesics prior to surgery
  • pregnancy
  • impaired renal function
  • impaired hepatic function
  • known impaired cardiac function
  • hypersensitivity to sodium metabisulfite

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01136668

Canada, Ontario
The Hospital for Sick Children
Toronto, Ontario, Canada, M5G 1X8
Sponsors and Collaborators
The Hospital for Sick Children
Principal Investigator: Jason Hayes, MD The Hospital for Sick Children, Toronto Canada

Responsible Party: Jason Hayes, Staff Anesthesiologist, The Hospital for Sick Children Identifier: NCT01136668     History of Changes
Other Study ID Numbers: 1000014754
First Posted: June 3, 2010    Key Record Dates
Last Update Posted: April 18, 2016
Last Verified: April 2016

Keywords provided by Jason Hayes, The Hospital for Sick Children:
Transversus Abdominis Plane Block
Ostomy Surgery
Regional Anesthetic