Ürolojik robotik cerrahilerde bölgesel analjezi tekniklerinin etkinliği: retrospektif klinik çalişma

Year 2022, Volume: 17 Issue: 3, 180 - 186, 27.10.2022

Sami Kaan Coşarcan , Alper Tunga Doğan Mert Kılıç Ömür Erçelen

https://doi.org/10.33719/yud.2022;17-3-1141735

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

References

• Schiffmann J, Larcher A, Sun M, et al. Differences in patient characteristics among men choosing open or robot-assisted radical prostatectomy in contemporary practice-analysis of surveillance, epidemiology, and end results database. Urol Int 2017;98(1):40-8. DOI: 10.1159/000447495.
• Aceto P, Beretta L, Cariello C, et al. Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva (SIAARTI), Società Italiana di Ginecologia e Ostetricia (SIGO), and Società Italiana di Urologia (SIU). Joint consensus on anesthesia in urologic and gynecologic robotic surgery: specific issues in management from a task force of the SIAARTI, SIGO, and SIU. Minerva Anestesiol. 2019;85(8):871-85. DOI: 10.23736/S0375-9393.19.13360-3.
• Woldu SL, Weinberg AC, Bergman A, et al. Pain and analgesic use after robot-assisted radical prostatectomy. J Endourol. 2014;28(5):544-8. DOI: 10.1089/end.2013.0783. Desai N, El-Boghdadly K, Albrecht E. Epidural vs. transversus abdominis plane block for abdominal surgery - a systematic review, meta-analysis and trial sequential analysis. Anaesthesia 2021;76(1):101-17. DOI: 10.1111/anae.15068.
• Taninishi H, Matsusaki T, Morimatsu H. Transversus abdominis plane block reduced early postoperative pain after robot-assisted prostatectomy: a Randomized controlled trial. Sci Rep. 2020;10(1):3761. DOI: 10.1038/s41598-020-60687-y.
• Tran DQ, Bravo D, Leurcharusmee P, et al. Transversus abdominis plane block: A narrative review. Anesthesiology 2019;131(5):1166-90.  DOI: 10.1097/ALN.0000000000002842.
• Kishikawa H, Suzuki N, Suzuki Y, et al. Effect of robot-assisted surgery on anesthetic and perioperative management for minimally Invasive radical prostatectomy under combined general and epidural anesthesia. J Nippon Med Sch 2021;88(2):121-7. DOI: 10.1272/jnms.JNMS.2021_88-304.
• Lemoine A, Witdouck A, Beloeil H, et al. PROSPECT Working group of the European society of regional anaesthesia and pain therapy (ESRA). PROSPECT guidelines update for evidence-based pain management after prostatectomy for cancer. Anaesth Crit Care Pain Med 2021;40(4):100922. DOI: 10.1016/j.accpm.2021.100922.
• Carney J, Finnerty O, Rauf J, et al. Studies on the spread of local anaesthetic solution in transversus abdominis plane blocks. Anaesthesia 2011;66(11):1023-30. DOI: 10.1111/j.1365-2044.2011.06855.x.
• Ma N, Duncan JK, Scarfe AJ, et al. Clinical safety and effectiveness of transversus abdominis plane (TAP) block in post-operative analgesia: a systematic review and meta-analysis. J Anesth 2017;31(3):432-52. DOI: 10.1007/s00540-017-2323-5.
• Chiancone F, Fabiano M, Ferraiuolo M, et al. Clinical implications of transversus abdominis plane block (TAP-block) for robot assisted laparoscopic radical prostatectomy: A single-institute analysis. Urologia 2021;88(1):25-9. DOI: 10.1177/0391560320957226.
• Tsai HC, Yoshida T, Chuang TY, et al. Transversus abdominis plane block: An Updated review of anatomy and techniques. Biomed Res Int 2017;2017:8284363. DOI: 10.1155/2017/8284363.
• Rogers T, Bhat KRS, Moschovas M, et al. Use of transversus abdominis plane block to decrease pain scores and narcotic use following robot-assisted laparoscopic prostatectomy. J Robot Surg 2021 Feb;15(1):81-6. DOI: 10.1007/s11701-020-01064-9.
• Shahait M, Yezdani M, Katz B, et al. Robot-assisted transversus abdominis plane block: description of the technique and comparative analysis. J Endourol 2019;33(3):207-10. DOI: 10.1089/end.2018.0828.
• Russo A, Romanò B, Papanice D, et al. Intrathecal morphine, transversus abdominis plane block, and tramadol Infusion for catheter-related bladder discomfort in patients undergoing robot-assisted laparoscopic prostatectomy (TORNADO): A Pilot prospective controlled study. J Clin Med 2022;11(8):2136. DOI: 10.3390/jcm11082136.
• Hong JY, Lee SJ, Rha KH, et al. Effects of thoracic epidural analgesia combined with general anesthesia on intraoperative ventilation/oxygenation and postoperative pulmonary complications in robot-assisted laparoscopic radical prostatectomy. J Endourol 2009;23(11):1843-9. DOI: 10.1089/end.2009.0059.
• Webster TM, Herrell SD, Chang SS, et al. Robotic assisted laparoscopic radical prostatectomy versus retropubic radical prostatectomy: a prospective assessment of postoperative pain. J Urol 2005;174(3):912-4. DOI: 10.1097/01.ju.0000169455.25510.ff.
• Oh YJ, Lee JR, Choi YS, et al. Randomized controlled comparison of combined general and epidural anesthesia versus general anesthesia on diaphragmatic function after laparoscopic prostatectomy. Minerva Anestesiol 2013;79(12):1371-80. https://pubmed.ncbi.nlm.nih.gov/23857436/.
• Shin S, Bai SJ, Rha KH, et al. The effects of combined epidural and general anesthesia on the autonomic nervous system and bioavailability of nitric oxide in patients undergoing laparoscopic pelvic surgery. Surg Endosc 2013;27(3):918-26. DOI: 10.1007/s00464-012-2536-5.
• Shim JW, Jung S, Moon HW, et al. Rectus sheath block for acute pain management after robot-assisted laparoscopic prostatectomy. Asian J Surg 2021:S1015-9584(21)00687-4. DOI: 10.1016/j.asjsur.2021.10.035.
• Shim JW, Cho YJ, Kim M, et al. Comparison of analgesic efficacy between rectus sheath blockade, intrathecal morphine with bupivacaine, and intravenous patient-controlled analgesia in patients undergoing robot-assisted laparoscopic prostatectomy: a prospective, observational clinical study. BMC Anesthesiol 2020;20(1):291. DOI: 10.1186/s12871-020-01208-2.