You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality of Life1 Apr 2011628 SURGEON-ADMINISTERED REGIONAL ANESTHESIA, USING THE TRANSVERSUS ABDOMINAL PLANE (TAP) BLOCK DURING RADICAL RETROPUBIC PROSTATECTOMY (RRP): A RANDOMIZED DOUBLE BLINDED, CONTROLLED TRIAL Shubha De, David Bell, Gordon Launcelott, Greg Bailly, Scott Bagnell, Joseph Lawen, Richard Norman, and Ricardo A. Rendon Shubha DeShubha De Halifax, Canada More articles by this author , David BellDavid Bell Halifax, Canada More articles by this author , Gordon LauncelottGordon Launcelott Halifax, Canada More articles by this author , Greg BaillyGreg Bailly Halifax, Canada More articles by this author , Scott BagnellScott Bagnell Halifax, Canada More articles by this author , Joseph LawenJoseph Lawen Halifax, Canada More articles by this author , Richard NormanRichard Norman Halifax, Canada More articles by this author , and Ricardo A. RendonRicardo A. Rendon Halifax, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1504AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Pain is a significant concern for patients considering an open RRP. Our center's post-RRP analgesic protocol includes scheduled acetaminophen, ibuprofen, breakthrough narcotics and anticholenergic/opiate suppositories. This has allowed discharge of 96% of our patients within 48 hours. By injecting local anesthetic into the interfascial plane containing sensory spinal nerves, the TAP block anesthetizes the anterior abdominal wall. Traditionally performed by anesthetists via ultrasound, it has not been evaluated systematically in patients undergoing RRP. We present the results of a double-blinded, control trial of surgeon-administered TAP blocks in patients undergoing RRP. METHODS After informed consent, 110 patients undergoing general anesthesia (GA) for RRP were randomized to blinded surgeon-administered bilateral TAP blocks using ropivicaine or saline injections. Blinded nursing staff recorded interval symptom scores (pain, nausea, sedation, and pruritis). Analgesic use, demographic and clinical characteristics were recorded. Descriptive statistics, regression analyses, and repeated measures analysis were used. RESULTS Of 110 patients, 16 were excluded due to chronic opiate use, or for requiring a secondary GA. Most patients had low/intermediate risk prostate cancer (low risk 43.1%, intermediate risk 41.9%). Total cases per surgeon ranged from 4 to 37 over the 10-month study period. Immediately following surgery, the TAP block arm reduced the total milligrams of opiates used by 28.7%, and the number of doses by 38.6% compared to the saline arm (p=0.02 and 0.046 respectively). At 24 hours, the intervention arm required 1/3 less opiate doses (p=0.023) compared to controls. Both static and dynamic pain were decreased by an average of 10% in the treatment arm (p=0.018, and 0.037 respectively) over 24hrs. Regression analysis identified one low volume surgeon, and longer operative time to negatively affect opiate requirements and pain scores. No side-effects were encountered. CONCLUSIONS This double blinded randomized controlled trial, demonstrates that a surgeon-administered regional block during open RRP decreases pain and opiate requirements. Of men receiving this adjunct to GA, 20% required no post-op narcotics. With no documented side-effects, this block provides an effective and low risk addition to current multimodal anesthesia strategies. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e253 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shubha De Halifax, Canada More articles by this author David Bell Halifax, Canada More articles by this author Gordon Launcelott Halifax, Canada More articles by this author Greg Bailly Halifax, Canada More articles by this author Scott Bagnell Halifax, Canada More articles by this author Joseph Lawen Halifax, Canada More articles by this author Richard Norman Halifax, Canada More articles by this author Ricardo A. Rendon Halifax, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...