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Comparison of Epidural and TAP Block in Abdominal Surgery

This study has been completed.
Information provided by (Responsible Party):
Thomas Nicholas IV MD, University of Nebraska Identifier:
First received: April 25, 2013
Last updated: December 16, 2016
Last verified: December 2016
This study intends to examine this rational by comparing the infiltrative transversusabdominis plane (TAP) block with liposomal bupivacaine to EA in major abdominal surgery . The efficacy of the TAP block for abdominal surgery is well documented in the literature (McDonnell 2007) (Kadam 2011), but there are no studies utilizing long-acting bupivacaine. The investigators believe the primary outcome will demonstrate no difference between the two in terms of pain scores and opioid consumption. The investigators anticipate that patients who have undergone TAP blocks will have improved secondary outcomes with respect to a decreased costs, urinary retention, and hypotension.

Condition Intervention
Acute Pain
Regional Anesthesia
Drug: Epidural
Drug: TAP Block

Study Type: Observational
Study Design: Time Perspective: Prospective
Official Title: Comparison of Epidural Analgesia With Bilateral Dual TAP Infiltration Block With Liposomal Bupivacaine in Patients With Major Abdominal Surgery

Further study details as provided by Thomas Nicholas IV MD, University of Nebraska:

Primary Outcome Measures:
  • Difference between the two in terms of pain scores andopioid consumption [ Time Frame: one year ]

Secondary Outcome Measures:
  • patients who have undergone TAP blocks will have improved secondary outcomes with respect to a decreased costs, urinary retention, and hypotension. [ Time Frame: 1 year ]

Enrollment: 72
Study Start Date: February 2014
Study Completion Date: December 2016
Primary Completion Date: December 2016 (Final data collection date for primary outcome measure)
Groups/Cohorts Assigned Interventions
The skin will be disinfected with 2% chlorhexidine. Under sterile technique, the epidural will be placed.Epidural catheter will be placed at thoracic vertebral levels T5 to T10. Level chosen as clinically indicated. The epidural solution should contain UNMCs standard solution of Bupivicaine 0.05% and hydromorphone 10 mcg/cc. However, solution type should be clinically indicated.
Drug: Epidural
TAP Block
The skin will be disinfected with 2% chlorhexidine. The bilateral dual TAP infiltrative blocks will be placed using high-frequency ultrasound.2.The TAP blocks will be performed using lipospheric bupivacaine (Exparel) with the following dosing regimen.A 266mg (20cc) vial of lipospheric bupivacaine will be equally into 2 30 ml syringes using strict sterile technique. The solution will be diluted in each syringe with 20cc preservative free sterile 0.9% normal saline to a total volume of 30 ml in each syringe. Once the transversus abdominal plane is identified then a 5-10 ml of plain 0.9% normal saline will be injected to open the fascial plane. Once the plane is opened then the 15cc of diluted lipospheric bupivacaine will be administered under direct ultrasound visualization in all 4 TAP quadrants ( subcostal position x2 and lateral position x2)
Drug: TAP Block


Ages Eligible for Study:   19 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Probability Sample
Study Population
Adult subjects undergoing major abdominal surgery

Inclusion Criteria:

  • subject >/= 19 years of age
  • Undergoing major abdominal surgery
  • able to provide written informed consent

Exclusion Criteria:

  • chronic opioid use
  • allergies to amide anesthetics
  • inability to undergo general anesthesia
  • pregnancy
  • any existence of contraindications to regional anesthesia in the presence of antiplatelet or anticoagulative drugs
  • or evidence of gross neurological dysfunction of the lower extremity
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Please refer to this study by its identifier: NCT01848951

United States, Nebraska
University of Nebraska Medical Center
Omaha, Nebraska, United States, 68198-4455
Sponsors and Collaborators
University of Nebraska
  More Information

Responsible Party: Thomas Nicholas IV MD, Assistant Professor, University of Nebraska Identifier: NCT01848951     History of Changes
Other Study ID Numbers: 287.13.FB
Study First Received: April 25, 2013
Last Updated: December 16, 2016

Additional relevant MeSH terms:
Acute Pain
Neurologic Manifestations
Nervous System Diseases
Signs and Symptoms
Anesthetics, Local
Central Nervous System Depressants
Physiological Effects of Drugs
Sensory System Agents
Peripheral Nervous System Agents processed this record on May 25, 2017