Pain Control after Laparoscopic Radical Prostatectomy: Comparison between Unilateral Transversus Abdominis Plane Block and Wound Infiltration

Abstract

Background and Objectives: To determine the efficacy of unilateral transversus abdominis plane (TAP) block versus wound local infiltration for postoperative pain following laparoscopic radical prostatectomy (LRP). Methods: Data of consecutive patients who underwent extraperitoneal LRP and received either wound infiltration or unilateral TAP block for analgesia were retrospectively analyzed. The patients were divided into 2 groups based on the technique used. We compared pain intensity scores and on-demand analgesic use both during the hospital stay and post-discharge between the 2 groups. Results: A total of 48 patients were included, 27 received unilateral TAP blocks (group 1) and 21 were managed with wound infiltration (group 2). The unilateral TAP block group showed lower median pain scores on postoperative days (POD) 1 with pain scores being 0.2 (0–4) and 0.8 (0–4), respectively (p < 0.05). On POD2, the median pain intensity was 0.9 (0–5) and 1.6 (0–6) in groups 1 and 2, respectively (p < 0.05). The median number of on-demand analgesic doses during the POD1 was 0.2 (0–2) and 0.4 (0–2) in groups 1 and 2, respectively (p = 0.19). On POD2, the patients received 0.5 (0–2) and 1.1 (0–3) on-demand doses in groups 1 and 2, respectively (p < 0.05). Conclusion: Unilateral TAP block might improve pain control more pronounced after LRP than wound infiltration.

Ultrasound–guided posterior quadratus lumborum block for postoperative pain control after minimally invasive radical prostatectomy: a randomized, double–blind, placebo–controlled trial

“…Despite being less invasive surgical interventions, laparoscopic procedures may still be demanding in terms of postoperative pain, because both somatic and visceral pain pathways are involved. Regional anesthesia techniques have been utilized to alleviate the pain and to optimize enhanced recovery after laparoscopic prostatectomy, with the aim to avoid or decrease the need for opioids (Bae et al, 2017[ 2 ]; Cacciamani et al, 2019[ 5 ]; Shahait and Lee, 2019[ 21 ]; Taha et al, 2019[ 22 ]). Truncal blocks as an addition to local wound infiltration have been used with promising outcomes and have proved to be superior to wound infiltration alone (Cacciamani et al, 2019[ 5 ]; Taha et al, 2019[ 22 ]).…”

“…Regional anesthesia techniques have been utilized to alleviate the pain and to optimize enhanced recovery after laparoscopic prostatectomy, with the aim to avoid or decrease the need for opioids (Bae et al, 2017[ 2 ]; Cacciamani et al, 2019[ 5 ]; Shahait and Lee, 2019[ 21 ]; Taha et al, 2019[ 22 ]). Truncal blocks as an addition to local wound infiltration have been used with promising outcomes and have proved to be superior to wound infiltration alone (Cacciamani et al, 2019[ 5 ]; Taha et al, 2019[ 22 ]). Transversus abdominis plane (TAP) block is currently recommended for laparoscopic and robotic prostatectomy by the recent procedure specific postoperative pain management (PROSPECT) guidelines (Lemoine et al, 2021[ 17 ]).…”

Wound infiltration or transversus abdominis plane block after laparoscopic radical prostatectomy: a randomized clinical trial

“…Several studies have compared the effectiveness of WI and TAP in different urologic [ 15 ], colonic [ 7 , 16 ], and gastrointestinal laparoscopic procedures [ 17 ], but no prospective comparative data are available for LRP.…”

Effect of Ultrasound-Guided Transversus Abdominis Plane Block Combined with Patient-Controlled Intravenous Analgesia on Postoperative Analgesia After Laparoscopic Cholecystectomy: a Double-Blind, Randomized Controlled Trial

“…6 Improvements have been made to TAPB with ultrasound guidance to confirm the proper region and avoid complications through direct needle visualization. 7,8 Combined analgesic regimens or multimodal approaches have been recommended in managing postoperative pain, minimizing the dose of medications and reducing adverse effects while still providing adequate analgesia. [9][10][11] As a newer technique, ultrasound-guided TAPB is more manageable and perhaps safer as part of multimodal analgesia.…”