Background and aims RALP is an increasingly emerging surgical approach for treating prostatic cancer. Patients treated with US-TAP block (TAPb) and rectus sheath blocks showed reduction in perioperative opioids administration and postoperative pain¹. Moreover analgesic effects of intrathecal morphine (IM) was described as its capacity in decreasing detrusor contractility and minctional urgency². the aim of this study was evaluate intra- and post-operative analgesic efficacy of IM administration coupled to TAPb in RALP.

Methods 55 ASA I-III patients were enrolled; all patients were under general anesthesia with US-TAPb (group A, 25 patients) and 30 patients received IM and TAPb and rectus sheath blocks (group B). Levobupivacaine 7,5mg and sulphate morphine 100mcg in 3ml of hydrosaline 0.9%, were used for subarachnoidal injections. All patients received postoperative multimodal analgesia with Paracetamol 3g/die iv. Ketoprofen and Tramadol were used as rescue drugs.

Results No complications were recorded. Intra- and post-operative drugs consumptions are shown in table 1.

Conclusions In our experience, a single IM injection at low dose coupled Levobupivacaine combined with and rectus sheath blocks abdominal wall blocks is safe, well tolerated, provides intraoperative lower opioid requirements, ensures postoperative analgesia and reduces PONV.

References

1. Ultrasound-guided transversus abdominis plane block (US- TAPb) for robot-assisted radical prostatectomy:a novel ‘4-point’ technique-results of a prospective, randomized study. Dal Moro F, et al. Journal of Robotic Surgeryhttps://doi.org/10.1007/s11701-018-0858-6

2. Intrathecal morphine for postoperative pain control following robot-assisted prostatectomy: a prospective randomized trial. Junyeol Bae, et al. J Anesth 2017;31:565–571