AUA 2019: Local Anaesthetic Wounds Infiltration and Ultrasound Transversus Abdominal Plane Block in Patients Undergoing Robot-assisted Radical Prostatectomy

Chicago, IL (UroToday.com) There is currently intense interest in effective postoperative pain control after urologic procedures with minimal to no use of opioid medications. Transversus abdominus plane (TAP) block has been evaluated previously in at least one retrospective trial1 and one prospective randomized trial2 demonstrating superiority over local port site infiltration for pain control after robotic assisted radical prostatectomy (RARP).  

In this double-blind randomized controlled trial, 100 men undergoing RARP were randomized to local wound infiltration with 20ccs of 0.35% ropivicaine with or without TAP block performed with an additional 20ccs. A significant difference in favor of TAP block was noted in the coprimary endpoints of mean numerical rating pain scale (2.7vs1.8; p=0.04) and number of opioid pills consumed (8 vs 2; p=0.01) in the first 24 hours. Length of stay and use of bowel motility agents also favored the TAP block group (4.7 vs 4.2; p= 0.04 and 31 vs 12; p < 0.001 respectively). No adverse effects were noted. This is an exciting and potentially practice changing finding, pending a full description of the trial and block technique employed.

Authors: Giovanni E. Cacciamani, Nicola Menestrina, Marco Pirozzi, Paolo corsi, Davide De Marchi, Davide Inverardi, Tania Processali, Nicolo' Trabacchin, Mario de Michele, Alessandro Tafuri, Marco Sebben, Maria Angela Cerruto, Vincenzo De Marco, Filippo Migliorni, Antonio Benito Porcaro, Walter Artibani. Verona, Italy

Written by: Marshall Strother, MD, Chief Resident, Division of Urology, University of Pennsylvania, Philadelphia PA at the 2019 AUA Annual Meeting - May 3-6, 2019 - Chicago, IL 

References:
1. Shahait M, Yezdani M, Katz B, Lee A, Yu SJ, Lee DI. Robot-Assisted Transversus Abdominis Plane Block: Description of the Technique and Comparative Analysis. J Endourol. 2019;33(3):207-210.
2. Dal moro F, Aiello L, Pavarin P, Zattoni F. Ultrasound-guided transversus abdominis plane block (US-TAPb) for robot-assisted radical prostatectomy: a novel '4-point' technique-results of a prospective, randomized study. J Robot Surg. 2019;13(1):147-151
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