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NCT07840183PHASE4Recruiting

Epidural Analgesia Versus Opioid-sparing Analgesia for Open Ventral Hernia Repair With Transversus Abdominis Release

Northwestern University

Start Date

9/25/2026

Completion Date

11/1/2027

Summary

This study is comparing two ways to manage pain after a major hernia repair surgery called "transversus abdominis release." One method uses an epidural, a small tube placed in the back that delivers pain medicine directly around the spine. The other method avoids the epidural and instead uses a combination of non-opioid pain medicines, along with an injection of numbing medicine into the abdominal wall during surgery. Patients who still have pain that is hard to control with either method will be given rescue pain medicine through an intravenous (IV) pump. Researchers want to learn which method controls pain better and results in patients using fewer opioid pain medicines after surgery. Participants will be randomly assigned (like a coin flip) to one of the two pain control methods. Pain levels and medication use will be tracked during the hospital stay, and participants will be contacted 30 days after surgery to check on recovery and any side effects.

Eligibility Criteria

Age Range: 18 years to 80 years

Inclusion Criteria: * Male or female patients ≥18 years old * Symptomatic incisional ventral or parastomal hernias * Planned transversus abdominis release * Ability to provide informed consent Exclusion Criteria: * Contraindications to epidural placement * Chronic pre-operative opioid use, defined as daily opioid use for 30-days prior to surgery * Allergy or intolerance to study medications * Age greater than 80 years * Impaired renal function - defined as creatinine clearance or estimated GFR of \<60ml/min * Planned ICU admissions with post-operative intubation * Urgent or emergent presentations * Adults unable to consent * Pregnant patients

Interventions

DRUG

Bupivicaine

DRUG

Fentanyl

DEVICE

Thoracic epidural analgesia

DRUG

Hydromorphone

DRUG

Acetaminophen

DRUG

Ketorolac

DRUG

magnesium sulfate

DRUG

Tramadol

DRUG

Gabapentin

DRUG

Cyclobenzaprine

PROCEDURE

transversus abdominis plane block

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Conditions

Ventral HerniaVentral Hernia RepairPostoperative Pain

Locations

Northwestern Memorial Hospital

Chicago, Illinois 60611

United States