Ultrasound-guided transversus abdominis plane block (US-TAPb) for robot-assisted radical prostatectomy: a novel '4-point' technique-results of a prospective, randomized study.

Abstract

Several works stress the importance of ultrasound-guided transversus abdominis plane block (TAPb) for post-operative analgesia and its versatility in all types of abdominal surgery, thanks to laparotomy and laparoscopy. The aim of this study was to evaluate the impact of TAPb on intra- and post-operative analgesia in the first 24h after robot-assisted radical prostatectomy (RARP). TAPb is a new local anesthetic technique which provides analgesia after abdominal surgery. It involves injection of local anesthetic into the plane between the transversus abdominis and the internal oblique muscles. TAPb can be performed according to a landmark technique, either through the lumbar triangle or with ultrasound guidance. We evaluated the intra- and post-operative analgesic efficacy of TAPb in 100 ASA I-III patients undergoing RARP under general anesthesia without (group A, 50 patients) or with US-TAPb (group B, 50 patients), in the first 24 post-operative hours. After induction of general anesthesia, US-TAPb was performed in 50 selected patients. All patients received post-operative analgesia (Paracetamol 1g) three times a day. Tramadol and Ketoprofen were used as rescue drugs if the Numerical Rating Scale test was > 3. No complications were recorded during block performance. A significant reduction was seen in the need to administer intraoperative opioids, and in the occurrence of post-operative pain or post-operative drug consumption in patients receiving US-TAPb. Seven patients, all in group A, received 100mg of Tramadol. In group B, only one patient received 100mg Tramadol (first and second post-operative days) due to surgical complications. In conclusion, US-TAPb provided highly effective intra- and post-operative analgesia in the first 24h after RARP. A further prospective study is necessary to assess the best protocol for all patients.