Category: Laparoscopic/ Robotic: Prostate
Introduction & Objective : The transversus abdominis plane (TAP) block has demonstrated improved postoperative analgesia following open radical prostatectomy. The technique has been modified to enable transperitoneal robot-assisted administration (RTAP) following robot-assisted radical prostatectomy (RARP) but its relative analgesic efficacy is unclear. We sought to compare the analgesic efficacy of the robot-assisted TAP (RTAP) block to the traditional TAP block as well as the current standard of local anesthetic infiltration at port sites.
Methods : We performed a 1:1:1 three-armed pilot study on 15 total patients undergoing RARP comparing RTAP blocks, TAP blocks, and port site infiltration. Each patient received a total of 20 mL 0.5% bupivacaine local anesthetic. Patient characteristics, as well as postoperative pain scores and total morphine equivalent usage, were obtained from the medical record. Statistical analysis was completed with ANOVA and chi-square test where appropriate.
Results : The TAP block extended surgery time by 33 minutes while RTAP block added 7 minutes relative to port site infiltration. Although the differences were not statistically significant due to sample size limitations of the pilot design, patient-reported pain scores were lower on average at each time point over the first 24 hours postoperatively for both RTAP and TAP blocks relative to port site infiltration. Total morphine equivalent usage following either RTAP or TAP block was about one half the usage following port site infiltration (RTAP 15mg, TAP 19.5mg, port site infiltration 31.5mg, p = 0.56).
Conclusions : RTAP block use during RARP is more rapid than TAP block administration though provides similar postoperative analgesic efficacy. RTAP block appears to offer superior postoperative analgesic efficacy relative to standard port site infiltration.
Mohammed Shahait– Fellow, Division of Urology, University of Pennsylvania , Philadelphia, Pennsylvania
Mark Hockenberry– , Philadelphia, Pennsylvania
Anthony Wang– , Philadelphia, Pennsylvania
Alice McGill– , Philadelphia, Pennsylvania
Kelly Monahan– , Philadelphia, Pennsylvania
Kellie McWilliams– , Philadelphia, Pennsylvania
Nabil Elkassabany– , Philadelphia, Pennsylvania
David Lee– associate professor of Urology, University of Pennsylvania, philadelphia, Pennsylvania
Division of Urology, University of Pennsylvania
Advanced Robotic Urology, University of Pennsylvania.
Interested in outcome research, new imaging modalities