V4-11: A Novel Transversus Abdominal Plane Block During Robotic Assisted Radical Prostatectomy
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INTRODUCTION
Robot assisted radical prostatectomy (RARP) has led to decreased patient morbidity and quicker convalescence. However, narcotic analgesics are still required by many patients and efforts to reduce use have been described. Percutaneous transversus abdominis plane (TAP) block has been well described in the literature to decrease postoperative pain. Classically, TAP block is done at the level of the anterior axillary line between the iliac crest and the costal margin and the analgesic is injected percutaneously through the external oblique, and infused between the internal oblique and transversus abdominis muscles (Figure 1). However, proper injection requires ultrasound guidance to place the medication in the proper layer. Our theory is that transperitoneal laparoscopy can provide easy visualization of the transversus abdominis thus obviating the need for ultrasound. Our goal was to evaluate a novel method utilizing a robotic assisted TAP block on postoperative pain in RARP._x000D_
METHODS
Ninety patients undergoing RARP received 10cc of 0.5% bupivacaine by infiltrating the laparoscopic port sites under our usual protocol (n=50) or a robot assisted TAP block with 10cc of 0.5% bupivacaine (n=40). One patient from each arm was excluded for opioid use preoperatively for chronic pain. Furthermore, all patients received around the clock ketorolac, and as needed oxycodone/acetaminophen, or regular acetaminophen in the postoperative period. All of the patients received standard general anesthetic. After the conclusion of the case, the TAP group received a robot-assisted TAP block of 5cc bilaterally by raising a wheal above the transversus abdominis muscle (Figure 2). Patients were assessed after the operation by a blinded registered nurse at 6 hour intervals until 24 hours after surgery. _x000D_
RESULTS
Robot assisted TAP block significantly reduced postoperative adjusted morphine equivalent consumption [mean (SD) 11.9 (13.3) vs. 19.7 (19.1) mg, P=0.0254]. Postoperative pain scale scores were also decreased in the TAP block group for all times with hours 6-12 postop being statistically significant [P=0.0075]. There were no adverse reactions attributable to the TAP block._x000D_
CONCLUSION
We have demonstrated a novel robot-assisted TAP block which shows considerable promise in not only decreasing our patients’ pain levels, but also reducing narcotic reliance and potentially avoiding undue deleterious effects. We have also simplified the technique by obviating the use of ultrasound via the direct visualization the laparoscopic approach provides._x000D_
Funding: None