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Abstract
Background and Aims The present study aimed at comparing the analgesic efficacy of intrathecal morphine and bupivacaine (ITMB) and rectus sheath block (RSB) in patients who underwent robotic-assisted laparoscopic prostatectomy (RALP).
Methods The institutional review board of Seoul St. Mary’s hospital granted this prospective observational study on April 29, 2020 (approval number: KC20OISI0124). Fifty patients scheduled for elective RALP were randomly allocated into the ITMB (n = 30) and RSB (n = 30) groups. The ITMB group received an intrathecal injection of 0.2 mg morphine and 7.5 mg bupivacaine, preoperatively. Using 20 mL of 0.25% bupivacaine, RSB was performed bilaterally after the induction of general anesthesia in the RSB group. The fentanyl-based patient-controlled analgesia was intravenously infused after surgery in all patients. Cumulative opioid consumption and the numeric rating scale (NRS) score were assessed at 1, 6, and 24 h postoperatively.
Demographic and intraoperative characteristics of the study and control groups. Abbreviations: ITMB, intrathecal morphine and bupivacaine; RSB, rectus sheath block NOTE: Values are expressed as mean (± SD), median (interquartile) and number (proportion)
Postoperative analgesic characteristics of the study and control groups. Abbreviations: ITMB, intrathecal morphine and bupivacaine; RSB, rectus sheath block; NRS, numeral rating scale; IV, intravenous; PACU, post-anesthesia care unit †Dose equianalgesic to morphine (mg) NOTE: Values are expressed as median (interquartile) and number (proportion)
Results Demographic findings were comparable between the two groups. During surgery, patients in the ITM group were administered less remifentanil than the RSB group. The ITM group showed significantly less NRS scores during rest and coughing, and less cumulative opioid consumptions at 1 h, 6 h, and 24 h after surgery. No significant differences in complications were observed, during or after surgery.
Conclusions ITMB enhanced analgesia during the early postoperative period in patients who underwent RALP, compared with RSB. The postoperative requirement for opioid analgesics were also significantly decreased in the ITMB group. Thus, intrathecal analgesia is considered an effective analgesic modality for RALP. Further studies are needed to promote patient recovery.