Analgesic Efficacy of Rectus Sheath Bupivacaine and Intrathecal Morphine With Bupivacaine Compared to Intravenous Patient-controlled Analgesia in Males Undergoing Robot-Assisted Laparoscopic Prostatectomy: A Prospective, Observational Parallel-Cohort Study

Abstract

Background: We explored the analgesic outcomes on postoperative day (POD) 1 of males undergoing robot-assisted laparoscopic prostatectomy (RALP) who received intravenous (IV) patient-controlled analgesia (PCA), a rectus sheath bupivacaine block (RSB), or an intrathecal morphine with bupivacaine (ITMB) block. Methods: This was a prospective, observational parallel-cohort trial. Patients were divided into three groups: IV-PCA (n = 30), RSB (n = 30), and ITMB block (n = 30). Peak pain scores at rest and when coughing, cumulative IV-PCA drug consumption, the need for IV rescue opioids, and Quality of Recovery-15 (QoR-15) questionnaire scores collected on POD 1 were compared among the groups.Results: The preoperative and intraoperative findings were comparable among the groups; the ITMB block group required the least remifentanil of all groups. During POD 1, the ITMB block group reported lower levels of pain at rest and when coughing than did the other two groups. After adjustment for age, body mass index, comorbidities, and intraoperative remifentanil infusion, severe pain at rest was 0.167-fold less common in the ITMB block than in the IV-PCA group, and pain when coughing was 0.1-fold lower in the ITMB block group and 0.306-fold lower in the RSB group compared to the IV-PCA group. The ITMB block group required lower cumulative IV-PCA drug infusions and less IV rescue opioids, and exhibited a better QoR-15 global score than did the other two groups.Conclusion: An ITMB block seems to provide appropriate analgesia with tolerable complications and enhances early patient recovery after RALP.Trial registration: Clinical Research Information Service, Republic of Korea, (approval number: KCT0005040) on May 20, 2020https://cris.nih.go.kr/cris/search/search_result_st01_kren.jsp?seq=15943&sLeft=2&ltype=my&rtype=my