Ürolojik robotik cerrahilerde bölgesel analjezi tekniklerinin etkinliği: retrospektif klinik çalişma

Abstract

Amaç: Robot yardımlı cerrahi, daha küçük kesiler, daha az postoperatif ağrı ve daha az intraoperatif kan kaybı ile günlük aktivitelere daha hızlı dönüş gibi avantajlar sunmaktadır. Torasik epidural analjezi, abdominal cerrahide mükemmel analjezi sağlar. Ancak özellikle torasik epidural analjezinin hipotansif etkisi minimal invaziv cerrahilerin hızlı iyileşmeye olan katkısını gölgede bırakmaktadır. Fasiyal plan blokları bu açıdan daha avantajlı olabilir. Bu çalışmada robotik prostatektomi, nefrektomi ve sistektomi operasyonlarında bölgesel analjezi tekniklerinin etkileri değerlendirildi.    
Gereç ve Yöntemler: Etik Kurul onayı (2021.467.IRB1.134) alındıktan sonra Ocak 2018 ile Ocak 2022 yılları arasında robotik prostatektomi, nefrektomi ve sistektomi ameliyatı geçiren hastaların kayıtları retrospektif olarak incelendi.
Bulgular: Tam dokümantasyona sahip yüz kırk hasta bu çalışmaya dahil edildi. Kullanılan bölgesel analjezi yöntemleri kayıt altına alındı. Epidural analjeziye ek olarak fasyal plan bloklarının kullanıldığı görüldü. Robotik prostat ameliyatlarında transversus abdominis plan ve rektus kılıf blokları, robotik nefrektomi ameliyatlarında ise transversus abdominis plan bloklarının etkili analjezik özellik gösterdiği görülmüştür.
Sonuç: Özellikle robotik prostatektomi operasyonlarında transversus abdominis plan bloğu ve rektus kılıf bloğu kombinasyonu etkili postoperatif analjezi sunmaktadır.

Keywords

• rejyonel anestezi
• robotik cerrahi
• radikal prostatektomi
• minimal invaziv cerrahi
• fasyal plan blokları

The efficacy of regional analgesia techniques in urological robotic surgeries: a retrospective clinical study

Abstract

Objective: The advantages of robot-assisted surgery include shorter incisions, less postoperative pain, perioperative blood loss, and a faster return to daily functions. Thoracic epidural analgesia (TEA) provides highly satisfactory analgesia in abdominal surgery. However, its hypotensive effect, particularly in minimally invasive procedures, exceeds its contribution to rapid recovery. Fascial plane blocks may be more beneficial in that context. This study evaluated the effects of regional analgesia techniques in robotic prostatectomy, nephrectomy, and cystectomy operations.
Material and Methods: Following IRB Ethics Committee approval (2021.467.IRB1.134), the records of patients who had undergone robotic prostatectomy, nephrectomy, and cystectomy surgeries were retrospectively reviewed between January 2018 and January 2022. 
Results: One hundred and forty patients with full documentation were included in this study. Various regional analgesia methods were used. Fascial plane blocks were seen to be used in addition to epidural analgesia. Transversus abdominis plane (TAP) and rectus sheath blocks exhibited satisfactory results in robotic prostate surgeries and TAP blocks in robotic nephrectomy operations.
Conclusion: In robotic prostatectomy and nephrectomy operations, we recommend fascial plane blocks as the first-choice method for postoperative analgesia.

Keywords

• regional anesthesia
• robotic surgery
• radical prostatectomy
• minimally invasive surgery
• fascial plane blocks
• recovery after surgery

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