The Effects of Ultrasound-Guided Transversus Abdominis Plane Block on Acute and Chronic Postsurgical Pain After Robotic Partial Nephrectomy: A Prospective Randomized Clinical Trial

Abstract

Background Use of a locoregional analgesia technique, such as the ultrasound-guided transversus abdominis plane block (TAPb), can improve postoperative pain management. We investigated the role of TAPb in robotic partial nephrectomy, a surgery burdened by severe postoperative pain. Methods In this prospective trial, patients with American Society of Anesthesiologists class I–III physical status undergoing robotic partial nephrectomy were randomly assigned to standard general anesthetic plus ultrasound-guided TAPb (TAP group) or sole standard general anesthetic (NO-TAP group). The primary end point was morphine consumption 24 hours after surgery. Secondary outcomes were postoperative nausea and vomiting in the first 24 hours, sensitivity, and acute and chronic pain, as measured by multiple indicators. Results A total of 96 patients were evaluated: 48 patients in the TAP group and 48 in the NO-TAP group. Median morphine consumption after 24 hours was higher in the NO-TAP group compared with the TAP group (14.1 ± 4.5 mg vs 10.6 ± 4.6, P < 0.008). The intensity of acute somatic pain and the presence of chronic pain at three and six months were higher in the NO-TAP group. Conclusions Our results show that TAPb can significantly reduce morphine consumption and somatic pain, but not visceral pain. TAPb reduced the incidence of chronic pain.

Transversus abdominis Plane Block for Improved Early Postoperative Pain Management after Periacetabular Osteotomy: A Randomized Clinical Trial

“…This may be a relevant aspect of the positive effect of the TAP. Due to the unilateral TAP block, it was possible to administer a higher dose of LA increasing this effect [3]. The 24 h-timepoint coincides with the first mobilisation of the patients.…”

“…ilioinguinalis, iliohypogastricus and spinal nerves of the anterolateral abdominal wall in the plane between internal oblique (IOAM) and transversus abdominis muscle (TAM) with local anaesthetics (LA) [1]. TAP block pro-vides effective pain management in patients undergoing abdominal and retroperitoneal surgery [2][3][4][5].…”

Ultrasound-triggered on Demand Lidocaine Release Relieves Postoperative Pain

“…Ultrasound, as an integral part of drug-delivery modalities, has many attractive features, including simplicity and cost-effectiveness [35]. Sonication can be performed noninvasively, and ultrasound waves can be directed to deep locations for precise energy-deposition patterns [36,37].…”

Do Small Incisions Need Only Minimal Anesthesia?—Anesthetic Management in Laparoscopic and Robotic Surgery

“…Regional anesthesia with transversus abdominis plane (TAP) block may become a further option to reduce intraoperative opioid requirements [66]. Ultrasound guided transversus abdominis plane block has been shown to reduce morphine consumption and somatic pain after robotic partial nephrectomy [67]. However, beneficial effects still remain controversial as only limited evidence for TAP block in laparoscopic surgery is available [68].…”