Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.03.021
Brazilian Journal of Anesthesiology
Clinical Research

Comparison between epidural technique and mid-axillary ultrasound-guided TAP block for postoperative analgesia of laparoscopic radical prostatectomy: a quasi-randomized clinical trial

Ana Tejedor, Carme Deiros, Marta García, Marina Vendrell, Nuria Gómez, Esther Gómez, Josep Masdeu

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Abstract

Background
Our goal was to evaluate whether TAP block offers the same analgesic pain control compared to epidural technique in laparoscopic radical prostatectomy surgery through the morphine consumption in the first 48 hours.

Methods
In this study, 45 patients were recruited and assigned to either TAP or epidural. The main study outcome was morphine consumption during the first 48 hours after surgery. Other data recorded were pain at rest and upon movement, technique-related complications and adverse effects, surgical and postoperative complications, length of surgery, need for rescue analgesia, postoperative nausea and vomiting, start of intake, sitting and perambulation, first flatus, and length of in-hospital stay.

Results
From a total of 45 patients, two were excluded due to reconversion to open surgery (TAP group = 20; epidural group = 23). There were no differences in morphine consumption (0.96 vs. 0.8 mg; p = 0.78); mean postoperative VAS pain scores at rest (0.7 vs. 0.5; p = 0.72); or upon movement (1.6 vs. 1.6; p = 0.32); in the TAP vs. epidural group, respectively. Sitting and perambulation began sooner in TAP group (19 vs. 22 hours, p = 0.03; 23 vs. 32 hours, p = 0.01; respectively). The epidural group had more technique-related adverse effects.

Conclusion
TAP blocks provide the same analgesic quality with optimal pain control than epidural technique, with less adverse effects.

Keywords

Prostatectomy,  Epidural analgesia,  Pain management,  Transversus abdominis block,  Enhanced recovery after surgery

References

1 H. Kehlet, D.W. Wilmore Evidence-based surgical care and the evolution of fast-track surgery Ann Surg, 248 (2008), pp. 189-198

2 J. Wind, S.W. Polle, P.H. Fung Kon Jin, et al. Laparoscopy and/or Fast Track Multimodal Management Versus Standard Care (LAFA) Study Group; Enhanced Recovery after Surgery (ERAS) Group. Systematic review of enhanced recovery programmes in colonic surgery Br J Surg, 93 (2006), pp. 800-809

3 P.C. Podore, E.B. Throop Infrarenal aortic surgery with a 3-day hospital stay: A report on success with a clinical pathway J Vasc Surg, 29 (1999), pp. 787-792

4 E.A. Tovar, R.A. Roethe, M.D. Weissig, et al. One-day admission for lung lobectomy: an incidental result of a clinical pathway Ann Thorac Surg, 65 (1998), pp. 803-806

5 N. Arumainayagam, J. McGrath, K.P. Jefferson, et al. Introduction of an enhanced recovery protocol for radical cystectomy BJU Int, 101 (2008), pp. 698-701

6 A. Magheli, N. Knoll, M. Lein, et al. Impact of Fast-track postoperative care on intestinal function, pain, and length of hospital stay after laparoscopic radical prostatectomy J endourol, 25 (2011), pp. 1143-1147

7 H. Kehlet, K. Holte Effect of postoperative analgesia on surgical outcome Br J Anaesth, 87 (2001), pp. 62-72

8 F. Bonnet, E. Marret Influence of anaesthetic and analgesic techniques on outcome after surgery Br J Anaesth, 95 (2005), pp. 52-58

9 M. Sugi, T. Matsuda, T. Yoshida, et al. Introduction of an Enhanced Recovery after Surgery Protocol for Robot-Assisted Laparoscopic Radical Prostatectomy Urol Int, 99 (2017), pp. 194-200

10 C. Lin, F. Wan, Y. Lu, et al. Enhanced recovery after surgery protocol for prostate cancer patients undergoing laparoscopic radical prostatectomy J Int Med Res, 47 (2019), pp. 114-121

11 G. Cacciamani, N. Menestrina, Pirozzi, et al. Impact of combination of local anesthetic wounds infiltration and ultrasound transversus abdominal plane block in patients undergoing robot-assisted radical prostatectomy: perioperative results of a double-blind randomized controlled trial J Endourol, 33 (2019), pp. 295-301

12 A. Gottschalk, D.S. Smith, D.R. Jobes, et al. Preemptive epidural analgesia and recovery from radical prostatectomy: a randomized controlled trial JAMA, 279 (1998), pp. 1076-1082

13 A. Rodgers, N. Walker, S. Schug, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials BMJ, 3212 (2000), pp. 1-12

14 W. Scott, N. Badner, P. Choi Epidural analgesia reduces postoperative myocardial infarction: a meta-analysis Anesth Analg, 93 (2001), pp. 853-858

15 M.A. Strafford, R.T. Wilder, C.B. Berde The risk of infection from epidural analgesia in children: a review of 1620 cases Anesth Analg, 80 (1995), pp. 234-238

16 A. Ahmed, T. Baig Incidence of lower limb motor weakness in patients receiving postoperative epidural analgesia and factors associated with it: an observational study Saudi J Anaesth, 10 (2016), pp. 149-153

17 G. Niraj, A. Kelkar, I. Jeyapalan Comparison of analgesic efficacy of subcostal transversus abdominis plane blocks with epidural analgesia following upper abdominal surgery Anaesthesia, 66 (2011), pp. 465-471

18 Y. Wu, F. Liu, H. Tang, et al. The analgesic efficacy of subcostal transversus abdominis plane block compared with thoracic epidural analgesia and intravenous opioid analgesia after radical gastrectomy Anest Analg, 117 (2013), pp. 507-513

19 X. Zhao, Y. Tong, H. Ren, et al. Transversus abdominis plane block for postoperative analgesia after laparoscopic surgery: a systematic review and meta-analysis Int J Clin Exp Med, 7 (2014), pp. 2966-2975

20 A. Sternlicht, M. Shapiro, G. Robelen, et al. Infiltration of liposome bupivacaine into the transversus abdominis plane for postsurgical analgesia in robotic laparoscopic prostatectomy: a pilot study Local Reg Anesth, 7 (2014), pp. 69-74

21 R. Tolstrup, J.A. Funder, L. Lundbech, et al. Perioperative pain after robot-assisted versus laparoscopic rectal resection Int J Colorectal Dis, 33 (2018), pp. 285-289

22 J. Carney, J.G. McDonnell, A. Ochana, et al. The transversus abdominis plane block provides effective postoperative analgesia in patients undergoing total abdominal hysterectomy Anesth Analg, 107 (2008), pp. 2056-2060

23 M. Torgeson, J. Kileny, C. Pfeifer, et al. Conventional Epidural vs Transversus Abdominis Plane Block with Liposomal Bupivacaine: A Randomized Trial in Colorectal Surgery J Am Coll Surg, 227 (2018), pp. 78-83

24 B. Pirrera, V. Alagna, A. Lucchi, et al. Transversus abdominis plane (TAP) block versus thoracic epidural analgesia (TEA) in laparoscopic colon surgery in the ERAS program Surg Endosc, 32 (2017), pp. 376-382

25 M. Baeriswyl, F. Zeiter, D. Piubellini, et al. The analgesic efficacy of transverse abdominis plane block versus epidural analgesia: A systematic review with meta-analysis Medicine (Baltimore), 97 (2018), Article e11261

26 O. Gralla, F. Haas, N. Knoll, et al. Fast-track surgery in laparoscopic radical prostatectomy: basic principles World J Urol, 25 (2007), pp. 185-191

27 R.H. Foster, A. Markham Levobupivacaine Drugs, 59 (2000), pp. 551-579

28 RD Miller Anestésicos locales Miller’s Anesthesia (8a edición), W B Saunders Co. (2014) p. 1212

29 M Sanford, GM Keating Lovobupivacaine: a review of its use in regional anaesthesia and pain management Drugs, 70 (2010), pp. 761-791

30 P. Mrunalini, N.V. Raju, V.N. Nath, et al. Efficacy of transversus abdominis plane block in patients undergoing emergency laparotomies Anesth Essays Res, 8 (2014), pp. 377-382

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