Analgesic combination for robot assisted laparoscopic radical prostatectomy; transversus abdominis plane block and rectus sheath block: Where and how?
Keywords:Regional anesthesia, Fascial plane blocks, Robot assisted surgery, Prostatectomy
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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