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Transversus Abdominis Plane (TAP) Block CatheterPhase 4NCT01398982

TAP Block in DIEP or Free MS-TRAM Donor Site: A RCT

A Phase 4 study testing Bupivacaine (study group) in people with Transversus Abdominis Plane (TAP) Block Catheter and DIEP or Free MS-TRAM Breast Reconstruction, run by University Health Network, Toronto at 1 site in Canada.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Breast reconstruction using a patient's own abdominal tissue is one of the most common methods for restoring mastectomy defects for breast cancer patients. Despite its increasing popularity and safety, the abdomen remains a major source of postoperative pain. Read more about this study

Who is it for?
Ages 18 years and older, women only
What is being tested?
Bupivacaine (study group)
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
93 participants
Where
1 siteCanada
Study dates
Jul 2011to Feb 2014
Phase
Phase 4
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • Women only
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • -Pre-operative eligibility:
  • Patients above the age of 18, no upper age limit
  • English-speaking
  • Delayed reconstruction (mastectomy already performed) or immediate reconstruction (mastectomy at the same time as reconstruction)
  • Reconstruction using abdominal tissues including free MS-TRAM or DIEP

Who cannot join

  • Patient refusal
  • Inability to give informed consent
  • BMI > 40
  • Allergy to Bupivacaine
  • Known cardiac or liver disease (contraindicated for Bupivacaine use)
  • Patients who will undergo any of the following:
Show all 13Show fewer
  • Implant breast reconstruction
  • Combined implant and autologous tissue reconstruction
  • Non-abdominally based autologous tissue reconstruction
  • Nonmicrosurgical abdominally based breast reconstruction (pedicled TRAM flap)
  • Drug addiction
  • Opioid tolerance defined as preoperative opioid use of >50 mg PO morphine equivalent
  • Psychiatric illness

Trial locations and contacts

1 site in 1 country.

Canada1 site
  • Toronto General Hospital

    Toronto, Ontario, M5G 2C4

Other trials in Canada

About this study

Official title: The Use of Transversus Abdominis Plane (TAP) Block in Autologous Breast Reconstruction Donor Site: A Randomized, Double-blind, Placebo-controlled Trial

Breast reconstruction using a patient's own abdominal tissue is one of the most common methods for restoring mastectomy defects for breast cancer patients. Despite its increasing popularity and safety, the abdomen remains a major source of postoperative pain. Adequate pain control is important as it has been shown to reduce medical complications, in-hospital death, shortens hospital stay, lessen chronic pain and disability, and in turn lower health-care costs. The current postoperative pain relief protocol consists primarily of a patient-controlled anesthesia device delivering intravenous opioids. Opioids can cause numerous side-effects such as sedation, headache, nausea, vomiting, breathing difficulties, bladder and bowel dysfunction. A promising approach to provide postoperative pain control of the abdominal incision is the newly developed transversus abdominis plane (TAP) peripheral nerve block. Although the TAP block has been found to be an effective pain-relief following major abdominal surgeries, its use has never been studied for breast reconstruction using abdominal tissue. Therefore, the investigators propose to rigorously study the efficacy of a TAP block in reducing postoperative abdominal pain following abdominal tissue breast reconstruction. This study has significant implications in improving both clinical care and health outcomes in patients undergoing this common method of breast reconstruction technique.

Read the detailed description
  1. Statement of Objectives/Specific Aims

The transversus abdominis plane (TAP) block is a newly developed block involving T6-L1 nerves that supply the anterior abdominal wall. Its effectiveness has been reported following major abdominal surgeries, but not following abdominally-based autologous tissue breast reconstruction. Thus, we propose a randomized, double-blind, placebo-controlled trial to evaluate the efficacy of TAP block in improving pain symptomatology following abdominally-based, autologous tissue breast reconstruction.

The primary objective of this study is to compare the mean total opioid consumption in the first postoperative 48 hours between the control and study groups in intravenous morphine equivalent units. By directly blocking the neural afferents, the mean opioid consumption will be significantly lower in the group receiving intermittent local anaesthetic boluses compared to the placebo group through a TAP catheter.

The secondary outcomes of interest are to compare the following parameters:

  1. Continuous outcomes i. Total in-hospital cumulative opioid consumption ii. Total in-hospital cumulative anti-nausea consumption iii. Quality of Recovery (QOR) score (0-18) iv. Duration of hospital stay
  2. Repeated measures outcomes

In Hospital postoperative measures:

  1. Daily pain intensity scores at rest and with movement using a visual pain analogue scale (0-10) ii. Postoperative nausea and vomiting (score of 0-3) iii. Sedation score

Long-term chronic pain, anxiety, function, and quality of life (QOL) measures:

iv. Pain disability index v. Short-form McGill Pain Questionnaire vi. Hospital Anxiety and Depression Scale vii. Short-form 36

  1. Time to event outcomes i. Time to first bowel movement ii. Time to ambulation

Hypothesis: Compared to the control group, the TAP block group will have a statistically significant reduction in total in-hospital consumption of opioids, pain scores and side-effects from opioid use such as sedation, nausea, and vomiting. This should also result in a greater QOR score in the TAP block group. Surgical milestones such as time to ambulation, first bowel movement, and duration of hospital stay will also be reduced in the TAP block group. In addition, we hypothesize less acute postoperative pain achieved using the TAP block will result in a reduction in chronic pain and disability, anxiety and depression, and improved QOL in the long-term.

Being tested
Bupivacaine (study group), Isotonic saline (control group)

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Bupivacaine (study group)Drug

    At the conclusion of the surgery, a 0.2 mL/kg bolus of 0.25% Bupivacaine will be injected through each catheter in the OR. At midnight following the OR, 0.2mL/Kg of 0.25% Bupivacaine will be injected through each catheter every 8 hours for the next 2 postoperative days by a MD member of the pain team. At 8am on postoperative day 3, the TAP catheters were removed by the pain team. Our rationale for decreasing the frequency of intermittent boluses from every 12 hours to 8 hours in this study design was based on our finding in the pilot study that patients frequently used more PCA between 8-12 hours following Bupivacaine bolus as the effect of the anaesthetic agent weaned off.

  • Isotonic saline (control group)Drug

    At the conclusion of the surgery, a 0.2 mL/kg bolus of Saline will be injected through each catheter in the OR. At midnight following the OR, 0.2mL/Kg of Saline will be injected through each catheter every 8 hours for the next 2 postoperative days by a MD member of the pain team. At 8am on postoperative day 3, the TAP catheters were removed by the pain team. Our rationale for decreasing the frequency of intermittent boluses from every 12 hours to 8 hours in this study design was based on our finding in the pilot study that patients frequently used more PCA between 8-12 hours following Bupivacaine bolus as the effect of the anaesthetic agent weaned off.

Study groups in NCT01398982
Study groupRoleWhat they receive
Isotonic saline (control group)Placebo comparatorAt the conclusion of the surgery, a 0.2 mL/kg bolus of Saline will be injected through each catheter in the OR. At midnight following the OR, 0.2mL/Kg of Saline will be injected through each catheter every 8 hours for the next 2 postoperative days by a MD member of the pain team. At 8am on postoperative day 3, the TAP catheters were removed by the pain team. Our rationale for decreasing the frequency of intermittent boluses from every 12 hours to 8 hours in this study design was based on our finding in the pilot study that patients frequently used more PCA between 8-12 hours following Bupivacaine bolus as the effect of the anaesthetic agent weaned off.
Receives: Drug: Isotonic saline (control group)
Bupivacaine (study group)ExperimentalAt the conclusion of the surgery, a 0.2 mL/kg bolus of 0.25% Bupivacaine will be injected through each catheter in the OR. At midnight following the OR, 0.2mL/Kg of 0.25% Bupivacaine will be injected through each catheter every 8 hours for the next 2 postoperative days by a MD member of the pain team. At 8am on postoperative day 3, the TAP catheters were removed by the pain team. Our rationale for decreasing the frequency of intermittent boluses from every 12 hours to 8 hours in this study design was based on our finding in the pilot study that patients frequently used more PCA between 8-12 hours following Bupivacaine bolus as the effect of the anaesthetic agent weaned off.
Receives: Drug: Bupivacaine (study group); Drug: Isotonic saline (control group)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Mean Total Opioid Consumption

    The primary objective of this study is to compare the mean total opioid consumption in the first postoperative 48 hours between the control and study groups in intravenous morphine equivalent units. By directly blocking the neural afferents, the mean opioid consumption will be significantly lower in the group receiving intermittent local anaesthetic boluses compared to the placebo group through a TAP catheter.

    Measured: first postoperative 48 hours

Secondary outcomes (13)
  1. Total In-hospital Cumulative Opioid Consumption

    Total in-hospital cumulative opioid consumption levels

    Measured: In-patient hospital stay average of 4 - 5 days

  2. Daily Pain Intensity Scores at Rest and With Movement

    Daily pain intensity scores at rest and with movement using a visual pain analogue scale (0-10)

    Measured: In Hospital postoperative measures, average 4-5 days

  3. Pain Disability

    Pain Disability Index Scores

    Measured: Hospital discharge, average 4-5 days, 6 months and 1 year following discharge

  4. First Bowel Movement

    Time to first bowel movement (# of days)

    Measured: In-patient hospital stay, average 4-5 days

  5. Anti-nausea Consumption

    Total in-hospital cumulative anti-nausea consumption

    Measured: In-patient hospital stay, average 4-5 days

  6. Quality of Recovery

    Quality of Recovery (QOR) score (0-18)

    Measured: In-patient hospital stay, first post operative 48 hours

  7. Duration of Hospital Stay

    Duration of hospital stay (# of days)

    Measured: In-patient hospital stay, average of 4-5 days

  8. Postoperative Nausea and Vomiting

    Postoperative nausea and vomiting (score of 0-3)

    Measured: In Hospital postoperative measures, average 4-5 days

  9. Sedation Level

    Sedation score in-patient

    Measured: In Hospital postoperative measures, average 4-5 days

  10. Pain Frequency and Intensity

    Short-form McGill Pain Questionnaire Score

    Measured: Hospital discharge, average 4-5 days, 6 months and 1 year following discharge

  11. Anxiety and Depression

    Hospital Anxiety and Depression Scale Score

    Measured: Hospital discharge, average 4-5 days, 6 months and 1 year following discharge

  12. Health Related Quality of Life

    Short-form health-related quality of life 36 Scores

    Measured: Hospital discharge, average 4-5 days, 6 months and 1 year following discharge

  13. Time to Ambulation

    Time to ambulation (# of days)

    Measured: In-patient hospital stay, average 4-5 days

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted21 Jul 2011 (estimated)
  2. Study startJul 2011
  3. Primary completionFeb 2014
  4. Study completionFeb 2014

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
93 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01398982
Sponsor's protocol ID
10-0969-A
Status last verified
Mar 2015
First submitted
18 Jul 2011
Last updated
1 Apr 2015
Data monitoring committee
No

Publications

  • Zhong T, Ojha M, Bagher S, Butler K, Srinivas C, McCluskey SA, Clarke H, O'Neill AC, Novak CB, Hofer SOP. Transversus abdominis plane block reduces morphine consumption in the early postoperative period following microsurgical abdominal tissue breast reconstruction: a double-blind, placebo-controlled, randomized trial. Plast Reconstr Surg. 2014 Nov;134(5):870-878. doi: 10.1097/PRS.0000000000000613.

    PubMed 25347623
  • Zhong T, Ojha M, Bagher S, Butler K, O'Neill AC, McCluskey SA, Clarke H, Hofer SO, Srinivas C. Transversus abdominis plane block following abdominally based breast reconstruction: study protocol for a randomized controlled trial. Trials. 2013 Dec 10;14:424. doi: 10.1186/1745-6215-14-424.

    PubMed 24325953

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Bupivacaine (study group) in people with Transversus Abdominis Plane (TAP) Block Catheter and DIEP or Free MS-TRAM Breast Reconstruction, run by University Health Network, Toronto at 1 site in Canada.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 13 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 1 Apr 2015. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 1 Apr 2015). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Mean Total Opioid Consumption (time frame: first postoperative 48 hours). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01398982, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 1 Apr 2015.

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