Laparoscopic Cholecystectomy and Quality of Recovery

Laparoscopic Cholecystectomy Clinical Trial

Official title:

The Effects of Subcostal Transversus Abdominis Plane Block and Port-site Infiltration on the Quality of Recovery of Patients Undergoing Laparoscopic Cholecystectomy

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT06321185
• Other study ID #: 2024/177
• Status: Recruiting
• Phase: N/A
• Start date: March 25, 2024
• Est. completion date: August 25, 2024

Study information

• Verified date: March 2024
• Source: Istanbul University
• Contact: Muserref B Dincer
• Phone: +905321624712
• Email: mberildincer[@]gmail.com
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This clinical trial aims to compare the Quality of Recovery-15 (QoR-15) scale scores in three groups of patients undergoing laparoscopic cholecystectomy. The first group will be applied subcostal transversus abdominis plane (subcostal TAP) block, the second group will receive local anesthetic infiltration into port sites, and the third group will receive only IV analgesics.

Description:

There are current approaches that search patients' perspectives to assess postoperative outcomes. In this regard, patient-centered outcomes are evaluated in clinical trials. It is recommended that patient comfort be assessed for short-term recovery after surgery. The Quality of Recovery-15 (QoR-15) scale is a defined patient comfort endpoint. This scale is a 15-item questionnaire that evaluates postoperative recovery as a patient-centered outcome. Each item is rated between 1 and 10, and the total score changes between 0 and 150. Improved recovery is associated with higher scores.

The subcostal transversus abdominis plane ( Subcostal TAP) block is used for analgesia in abdominal surgeries, including laparoscopic cholecystectomy. Local anesthetics are injected between the rectus abdominis and transversus abdominis muscles along the oblique subcostal line. Local anesthetic infiltration into the laparoscopic port sites is also used for analgesia in laparoscopic cholecystectomy.

The primary outcome of this study is to evaluate the effects of subcostal TAP block and port-site infiltration on the quality of recovery of patients undergoing laparoscopic cholecystectomy. Secondary outcomes are to evaluate Numerical Rating Scale (NRS) scores at time intervals, postoperative rescue analgesic requirement, total consumption of postoperative opioid analgesics, and presence of nausea and vomiting, for the postoperative 24 hours.

This study will be conducted as a prospective randomized clinical trial. The patients scheduled for elective laparoscopic cholecystectomy will be screened for enrollment in the study. After assessment for eligibility, the patients will be randomly allocated into three groups.

For the first group, a subcostal TAP block will be applied after intubation and before surgery. A local anesthetic solution of 20 ml 0.25% bupivacaine for each side will be injected bilaterally between the rectus abdominis and transversus abdominis muscles along the oblique subcostal line. For the second group, after intubation and before port placements, a solution of 20 ml 0.25% bupivacaine will be infiltrated into the laparoscopic port sites. The third group will not have an intervention or local anesthetic administration, and a multimodal routine IV analgesic regimen will be administered intraoperatively (1 gr paracetamol, 8 mg lornoxicam and 1mg/kg tramadol). This IV analgesic regimen will be applied to all patients included in the study. The patients will not know to which group they are allocated. Standard anesthesia protocol will be applied to all patients.

At the ward, patients will receive a standard postoperative multimodal analgesia protocol comprising paracetamol and lornoxicam. At the Numerical Rating Scale (NRS), pain is rated on a scale from 0 (no pain) to 10 (worst pain) and will be assessed at time intervals both at rest and during movement for postoperative 24 hours. A rescue analgesic IV 50 mg tramadol will be applied if it is four or higher. The healthcare provider will be blinded to which group the patient is in. All NRS scores, the requirement for rescue analgesics and total consumption, and the presence of nausea and vomiting for the postoperative 24 hours will be recorded by blind outcome assessors.

The Quality of Recovery-15 (QoR-15) scale will be evaluated before the surgery in the waiting area and at the postoperative 24th hour in the ward. The outcome assessor questioning QoR-15 will be blinded to which group the patient is allocated to.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 150
• Est. completion date: August 25, 2024
• Est. primary completion date: August 25, 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 80 Years

Eligibility

Inclusion Criteria:

• Patients scheduled for elective laparoscopic cholecystectomy

• Patients aged 18 to 80

• American Society of Anesthesiology (ASA) physical status I-II

• Signed informed consent

Exclusion Criteria:

• Patient refusal and inability to provide informed consent

• Known allergy to local anesthetics

• Severe kidney or liver disease

• Altered level of consciousness

• Inability to communicate due to language barrier

• Diagnosis of mental or psychiatric disorder

• Presence of coagulation disorder

• Contraindications to regional anesthesia

• Contraindications to any drug applying in the study

• Presence of coagulation disorder

• Chronic opioid intake

• Body mass index (BMI) = 40 kg/m2

• History of alcohol or drug abuse

• Changed surgical technique from laparoscopic to open.

Related Conditions & MeSH terms

• Laparoscopic Cholecystectomy

Intervention

Procedure:
• Subcostal TAP block
Subcostal TAP block will be applied after intubation and before surgery. A local anesthetic solution of 20 ml 0.25% bupivacaine for each side will be injected bilaterally between the rectus abdominis and transversus abdominis muscles along the oblique subcostal line. A multimodal routine IV analgesic regimen will be administered intraoperatively (1 gr paracetamol, 8 mg lornoxicam and 1mg/kg tramadol). Patients will receive a standard postoperative multimodal analgesia protocol comprising paracetamol and lornoxicam at the ward. Pain severity will be assessed with a Numeric Rating Scale (NRS) rated between 0 and 10; a rescue analgesic IV 50 mg tramadol will be applied when it is four or higher.

Other:
• Port site local anesthetic infiltration
After intubation and before port placements, a solution of 20 ml 0.25% bupivacaine will be infiltrated into the laparoscopic port sites. A multimodal routine IV analgesic regimen will be administered intraoperatively (1 gr paracetamol, 8 mg lornoxicam and 1mg/kg tramadol). Patients will receive a standard postoperative multimodal analgesia protocol comprising paracetamol and lornoxicam at the ward. Pain severity will be assessed with a Numeric Rating Scale (NRS) rated between 0 and 10; a rescue analgesic IV 50 mg tramadol will be applied when it is four or higher.
• No intervention or local anesthetic administration
There will not be an intervention or local anesthetic administration. A multimodal routine IV analgesic regimen will be administered intraoperatively (1 gr paracetamol, 8 mg lornoxicam and 1mg/kg tramadol). Patients will receive a standard postoperative multimodal analgesia protocol comprising paracetamol and lornoxicam at the ward. Pain severity will be assessed with a Numeric Rating Scale (NRS) rated between 0 and 10; a rescue analgesic IV 50 mg tramadol will be applied when it is four or higher.

Locations

Country	Name	City	State
Turkey	Istanbul University Istanbul Medical Faculty, Department of Anesthesiology and Reanimation	Istanbul	Fatih

Sponsors (1)

Lead Sponsor	Collaborator
Istanbul University

Country where clinical trial is conducted

Turkey, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Quality of Recovery-15 (QoR-15) scale	Quality of Recovery-15 scale is a 15-item questionnaire that evaluates postoperative recovery as a patient-centered outcome. Each item is rated between 0 and 10, and the total score changes between 0 and 150. Improved recovery is associated with higher scores. Postoperative score at the 24th hour will be assessed as the primary outcome.	24 hours
Secondary	Postoperative rescue analgesic requirement	IV 50 mg tramadol will be administered as a rescue analgesic when patients Numerical Rating Scale (NRS) score is 4 and higher.	24 hours
Secondary	Consumption of postoperative opioid analgesics	IV 50 mg tramadol will be administered when patients Numerical Rating Scale (NRS) score is 4 and higher. Total given dose of tramadol will be questioned.	24 hours
Secondary	Numerical Rating Scale (NRS) scores	On the Numerical Rating Scale, pain is rated on a scale from 0 (no pain) to 10 (worst pain) and will be assessed at time intervals both at rest and during movement. Higher scores are related to severe pain.	24 hours
Secondary	Postoperative nausea and vomiting	The presence of nausea and vomiting will be recorded postoperatively.	24 hours