Ultrasound-guided Transversus Abdominis Plane (TAP) block for Robot-Assisted Radical Prostatectomy: A novel “4-point” technique

Introduction & Objectives: Several works underlines the importance of ultrasound-guided Transversus Abdominis Plane (TAP) block for postoperative analgesia and its versatility in every type of abdominal surgery, through laparotomic and laparoscopic via. The aim of this study was to evaluate the impact of TAP block on intra- and post-operative analgesia in the first 24 hours after Robot-Assisted Radical Prostatectomy (RARP). Material & Methods: TAP block is a new regional anaesthesia technique that provides analgesia after abdominal surgery. It involves 4 injections of local anaesthetic into the plane between the transversus abdominis and the internal oblique muscles. The TAP block can be performed using a landmark technique through the lumbar triangle or with ultrasound guidance. We evaluated the intra- and postoperative analgesic efficacy in 60 ASA I-III patients undergoing RARP under general anaesthesia without (A group, 30 patients) or with US-TAP block (B group, 30 patients), in the first 24 postoperative hours. After induction of general anesthesia, the US-TAP block was performed at 30 selected patients with Levobupivacaine at the dose of 150mg for each patient. All patients received postoperative analgesia with 1gr of Paracetamol three times a day, Tramadol and Ketoprofen were used as rescue drugs, whether NRS was >3. Results: No complication was recorded during block performance. We observed a significant reduction in intraoperative opioids administration, postoperative pain and postoperative drugs consumption in patients treated with US-TAP block (Tab 1). Seven patients, in A group, received Tramadol 100mg. In B group only one patient received Tramadol 100mg, (first and second postoperative days) for surgical complications.