1 Departments of Urology, Italy.
2 Department of Anesthesiologist and Intensive Care University of Verona, Italy.
J Endourol. 2019 Apr;33(4):295-301. doi: 10.1089/end.2018.0761. Epub 2019 Jan 31.
To determinate benefits of the combination of local anesthetic wounds infiltration and ultrasound transversus abdominal plane (US-TAP) block with ropivacaine on postoperative pain, early recovery, and hospital stay in patients undergoing robot-assisted radical prostatectomy (RARP).
The study is double-blinded randomized controlled trial. Our hypothesis was that the combination of wound infiltration and US-TAP block with ropivacaine would decrease immediate postoperative pain and opioids use. Primary outcomes included postoperative pain and opioids demand during the hospital stay. Secondary outcomes were nausea/vomiting rate, stool passing time, use of prokinetics, length of hospital stay (LOS), and 30-days readmission to the hospital for pain or other US-TAP block-related complications.
A total of 100 patients who underwent RARP were eligible for the analysis; 57 received the US-TAP block with 20 mL of 0.35% ropivacaine (US-TAP block group) and 43 did not receive US-TAP block (no-US-TAP group). All the patients received the local wound anesthetic infiltration with 20 mL of 0.35% ropivacaine. US-TAP block group showed a decreased mean Numerical Rating Scale (NRS) within 12 hours after surgery (1.6 vs 2.6; p = 0.02) and mean NRS (1.8 vs 2.7; p = 0.04) with lesser number of patients who used opioid (3.5% vs 18.6%; p = 0.01) during the first 24 hours. Moreover, we found a shorter mean LOS (4.27 vs 4.72, days; p = 0.04) with a lower requirement of prokinetics administration during the hospital stay (21% vs 72%; p < 0.001). No US-TAP block-related complications were reported.
Combination of anesthetic wound infiltration and US-TAP block with ropivacaine as part of a multimodal analgesic regimen can be safely offered to patients undergoing RARP and extended pelvic lymph node dissection. It improves the immediate postoperative pain control, reducing opioids administration and is associated to a decreased use of prokinetics and shorter hospital stay.
确定局部麻醉伤口浸润联合罗哌卡因腹横肌平面（US-TAP）阻滞在机器人辅助前列腺根治术（RARP）患者中的术后疼痛、早期恢复和住院时间方面的益处。
这是一项双盲随机对照试验。我们的假设是，伤口浸润联合 US-TAP 阻滞与罗哌卡因的联合应用可以减轻术后即刻疼痛和阿片类药物的使用。主要结局包括住院期间的术后疼痛和阿片类药物需求。次要结局是恶心/呕吐发生率、排便时间、使用促动力药物、住院时间（LOS）和 30 天因疼痛或其他 US-TAP 阻滞相关并发症再次入院。
共有 100 名接受 RARP 的患者符合分析条件；57 名患者接受了 20ml 0.35%罗哌卡因的 US-TAP 阻滞（US-TAP 阻滞组），43 名患者未接受 US-TAP 阻滞（无 US-TAP 组）。所有患者均接受了 20ml 0.35%罗哌卡因的局部伤口麻醉浸润。US-TAP 阻滞组术后 12 小时内平均数字评分量表（NRS）降低（1.6 比 2.6；p=0.02），术后 24 小时内平均 NRS（1.8 比 2.7；p=0.04）较低，使用阿片类药物的患者人数较少（3.5%比 18.6%；p=0.01）。此外，我们发现平均 LOS 更短（4.27 比 4.72，天；p=0.04），住院期间需要使用促动力药物的人数更少（21%比 72%；p<0.001）。未报告与 US-TAP 阻滞相关的并发症。
作为多模式镇痛方案的一部分，局部麻醉伤口浸润联合罗哌卡因腹横肌平面阻滞可安全应用于接受 RARP 和广泛盆腔淋巴结清扫术的患者。它可以改善术后即刻疼痛控制，减少阿片类药物的使用，并与减少促动力药物的使用和缩短住院时间相关。
