Abstract
Analgesic effect of transversus abdominis plane block (TAP block) in lower major abdominal laparoscopic surgery with about 5 cm of maximum surgical scar has been controversial. We hypothesized that TAP block has benefits, so the analgesic effect of TAP block after robot-assisted laparoscopic prostatectomy (RALP) was evaluated. One hundred patients were enrolled in this prospective, double-blinded, randomized study. Standardized general anesthesia with wound infiltration on camera port and fentanyl dose limit of 3 µg/kg was provided. Ultrasound-guided, single-shot subcostal TAP block with either 0.375% ropivacaine (Ropivacaine group, 48 patients) or normal saline (Control group, 52 patients) was performed by anesthesiologist in charge (34 anesthesiologists) after surgical procedure. Pain score using numerical rating scale (NRS) and postoperative intravenous fentanyl were evaluated for the first 24 postoperative hours. Median values (interquartile range) of NRS scores when the patients were transferred to post-anesthesia care unit (PACU) were 5 (2–7) in Ropivacaine group and 6 (4–8) in Control group at rest (P = 0.03), 5 (2–8) in Ropivacaine group and 7 (5–8) in Control group during movement (P < 0.01). These significant differences disappeared at the time of discharging PACU. Fentanyl doses for the first 24 postoperative hours were 210 µg (120–360) in Ropivacaine group and 200 µg (120–370) in Control group (P = 0.79). These results indicated that subcostal TAP block by anesthesiologists of varied level of training reduced postoperative pain immediate after RALP. TAP block had fundamental analgesic effect, but this benefit was too small to reduce postoperative 24-hour fentanyl consumption.
Highlights
We hypothesized that TAP block in lower major abdominal laparoscopic surgery reduces postoperative pain
A total of 135 patients were scheduled for robot-assisted laparoscopic prostatectomy (RALP), and 125 patients were eligible for this study
Since group assignment was open after final data acquisition, 48 cases were assigned to Ropivacaine group and 52 cases were assigned to Control group
Summary
We hypothesized that TAP block in lower major abdominal laparoscopic surgery reduces postoperative pain. We obtained data for cases of robot-assisted laparoscopic prostatectomy (RALP) because we have enough number. Of patients, maximum surgical scar is ≈5 cm as colectomy, degrees of surgical invasion for patients are equivalent because of small bias of surgical skills between surgeons by robot assistance. The primary objective of this study was postoperative pain when the patients transferred to post-anesthesia care unit (PACU) both at rest and during movement, and the secondary objective was opioid consumption during the first 24-hour period after RALP
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