Analgesic combination for robot assisted laparoscopic radical prostatectomy; transversus abdominis plane block and rectus sheath block: Where and how?

Authors

DOI:

https://doi.org/10.18203/issn.2454-2156.IntJSciRep20211457

Keywords:

Regional anesthesia, Fascial plane blocks, Robot assisted surgery, Prostatectomy

Abstract

One of the common arguments for advantages of minimally invasive surgery is reduced postoperative pain and faster recovery. Faster recovery is expected with less postoperative pain in robotic surgeries. Robot-assisted radical prostatectomy causes considerable discomfort, mainly during the first postoperative day. The discomfort originates from abdominal pain, bladder spasm and transurethral catheter irritation. We would like to share our experience on use of bilateral subcostal mid axillar TAP block and rectus sheath block for postoperative analgesia in five male patients who underwent robot assisted radical prostatectomy surgery. General anesthesia was performed with 2mg/kg propofol, 1 μg/kg fentanyl, 0.6 mg/kg rocuronium. Anesthesia was maintained by remifentanil infusion and 1 MAC desflurane. After the surgery, TAP block and rectus sheath block performed in supine position. Blocks were done under ultrasound guidance. After the block, patients were extubated. At the end of the surgery patients were administered 1g paracetamol and tramadol 50 mg intravenous. Patients had intravenous tramadol PCA (only bolus dose 10 mg). Rescue analgesia was planned as tramadol 50 mg boluses if VAS scores were above 4 in recovery unit. Neither patient required rescue analgesia nor PCA bolus doses in recovery unit. All patients were satisfied with the analgesia quality. TAP block and rectus sheet block is a very effective combination in robotic prostate surgeries. Perhaps the most important thing is the selection of the most effective analgesic method that contributes to the rapid recovery of the patient.

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References

Schiffmann J, Larcher A, Sun M, Tian Z, Berdugo J, Leva I, et al. Differences in patient characteristics among men choosing open or robot-assisted radical prostatectomy in contemporary practice-analysis of surveillance, epidemiology, and end results database. Urol Int. 2017;98(1):40-8.

Woldu SL,Weinberg AC, Bergman A. Painandanalgesic use after robot-assisted radical prostatectomy. J Endourol. 2014;28:544-8.

Desai N, El-Boghdadly K, Albrecht E. Epidural vs. transversus abdominis plane block for abdominal surgery: a systematic review, meta-analysis and trial sequential analysis. Anaesthesia. 2021;76(1):101-17.

Tran DQ, Bravo D, Leurcharusmee P, Neal JM. Transversus abdominis plane block: a narrative review. Anesthesiol. 2019;131(5):1166-90.

Chiancone F, Fabiano M, Ferraiuolo M, de Rosa L, Prisco E, Fedelini M, et al. Clinical implications of transversus abdominis plane block (TAP-block) for robot assisted laparoscopic radical prostatectomy: A single-institute analysis. Urologia. 2020;18:391-6.

Rozen WM, Tran TM, Ashton MW, Barrington MJ, Ivanusic JJ, Taylor GI. Refining the course of the tho- racolumbar nerves: a new understanding of the innervation of the anterior abdominal wall. Clin Anat. 2008;21:325-33.

Abdallah FW, Laffey JG, Halpern SH, Brull R. Duration of analgesic effectiveness after the posterior and lateral transversus abdominis plane block techniques for transverse lower abdominal incisions: A meta-analysis. Br J Anaesth. 2013;111: 721-35.

Chiancone F, Fabiano M, Ferraiuolo M, de Rosa L, Prisco E, Fedelini M, et al. Clinical implications of transversus abdominis plane block (TAP-block) for robot assisted laparoscopic radical prostatectomy: A single-institute analysis. Urologia. 2021;88(1):25-9.

Elkassabany N, Ahmed M, Malkowicz SB, Heitjan DF, Isserman JA, Ochroch EA. Comparison between the analgesic efficacy of transversus abdominis plane (TAP) block and placebo in open retropubic radical prostatectomy: a prospective, randomized, double-blinded study. J Clin Anesth. 2013;25(6):459-65.

Cacciamani GE, Menestrina N, Pirozzi M, Tafuri A, Corsi P, De Marchi D, et al. Impact of combination of local anesthetic wounds ınfiltration and ultrasound transversus abdominal plane block in patients undergoing robot-assisted radical prostatectomy: perioperative results of a double-blind randomized controlled trial. J Endourol. 2019; 33(4):295-301.

Dal Moro F, Aiello L, Pavarin P, Zattoni F. Correction to: Ultrasound-guided transversus abdominis plane block (US-TAPb) for robot-assisted radical prostatectomy: a novel '4-point' technique-results of a prospective, randomized study. J Robot Surg. 2019;13(1):153-4.

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Published

2021-04-22

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