Clinical implications of transversus abdominis plane block (TAP-block) for robot assisted laparoscopic radical prostatectomy: A single-institute analysis

Abstract

Introduction: The aim of this study was to evaluate the role of TAP block in improvement of anesthesiological management and perioperative surgical outcomes of robot-assisted laparoscopic radical prostatectomy (RALP). Methods: We consecutive enrolled 93 patients with prostate cancer whose underwent RALP at our department from January 2019 to December 2019. Group A included 45 patients who received bilateral TAP block, and Group B included 48 patients who did not received TAP block. TAP blocks were always performed by a single anesthesia team. An elastomeric pump device was used in all patients for post-operative pain management. TAP block was performed according to Rafi’s technique, with Ropivacaine 0.375% and dexamethasone 4 mg. Mean values with standard deviations (±SD) were computed and reported for all items. Statistical significance was achieved if p-value was ⩽0.05 (two-sides). Results: The two groups showed no difference in the most important demographics and baseline characteristics ( p > 0.05). Group A showed a significant longer time of anaesthesia. Moreover, Ketorolac doses (started dose plus continuous post-operative infusion via elastomeric pump) used in Group A were significantly lower than Group B. Despite this, Group B showed statistical significant higher value of NRS PACU and at 12, 24, 48, 72 h than Group A but not at 96 h. Rescue analgesic medication use was significantly higher in the Group B than Group A. Moreover, patency of the intestinal tract and time to ambulation was significantly lower in the Group A. Discussion: The use of TAP block during a RALP is a safe procedure that can be applied more appropriately to achieve better pain control. A multimodal protocol that includes locoregional anesthesia, reduction of intra and postoperative use of strong opiates, correct placing of the patient and the use of low pneumoperitoneum pressures should be implemented in order to reach a faster and better post-operative full recovery of patients whose underwent RALP.

Intraoperative Strategies to Reduce Catheter-Related Bladder Discomfort in the Early Postoperative Period after Robot-Assisted Radical Prostatectomy

“…21–25 One single-center prospective study evaluated TAP block in the RARP population and found lower postoperative pain, lower pain medication doses and faster recovery. 26 A TAP block is part of our standard of care because it intends to decrease intraoperative pain due to distension of the pneumoperitoneum to lower the required dose of opioids for optimal pain management. Added benefit of the TAP block is reduced postoperative pain.…”

The efficacy of regional analgesia techniques in urological robotic surgeries: a retrospective clinical study

“…The subcostal approach is most frequently recommended for upper abdominal procedures, while the lateral and posterior approaches are suitable for lower abdominal procedures (9,10). Chiancone et al reported that TAP block provided satisfactory analgesia in robotic prostate surgeries in a 93-case series (11). Pain management in patients undergoing robot-guided procedures can be uncertain and difficult.…”

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

“…Chiancone et al showed that bilateral tap block very effective in robotic prostatectomy operations. 8 Elkassabany et al conducted a prospective, randomized double-blinded study evaluating the effects of ultrasound guided TAP block (20 ml of 0.5% bupivacaine) vs. placebo on pain control within 24 h after open retropubic robotic prostatectomy. 9 They showed that the TAP block group had lower pain scores and required less opioid administration in the immediate time after the surgery.…”

“…Unlike postoperative pain after open surgery, which is mostly of somatic origin, postoperative pain after laparoscopic surgery consists of both somatic and visceral elements. 5 Current study share the 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.…”