The transversus abdominis plane (TAP) block involves the sensory afferents of the anterior abdominal wall (T7-L1). It has been described as an alternative to epidural analgesia in retropubic radical prostatectomy without prolonged hospital stay.
This retrospective observational study was performed through electronic clinical process consultation, from January to November 2017. Patients were divided into two groups: the TAP group – bilateral block with 0.5% Ropivacaine (20mL for each side) was performed after induction - and the Non-TAP group. General anesthesia was inducted with intravenous fentanil, propofol and rocuronium and maintained with desflurane. Both groups had the same conventional analgesia protocol for the postoperative period – tramadol 100 mg plus droperidol 0.625 mg every 8h and paracetamol 1g every 6h; morphine was prescribed in SOS.
We reviewed demographic characteristics, consumption of opioids in the intra and 24 hour-postoperative period, pain at rest and on movement during 24 hours, time in the recovery room, conscience level, timing of the first rescue analgesia and nausea and vomiting episodes.
Statistical analysis was performed using SPPS 20, with the Fisher test for categorical variables and the Mann-Whitney test for continuous variables. A P value <0.05 was considered as statistically significant.
37 patients were included (12 in the TAP group, 25 in the Non-TAP group). Both groups were comparable in terms of demographic and surgical parameters. Mean fentanil consumption during intraoperative period was 0.167 mg in the TAP group versus 0.344 mg in the Non-TAP group (p<0.001). There was lower morphine consumption and pain intensity at rest and on movement up to 4 hours in the TAP group. Similarly, to other variables, this difference was not statistically significant. 
Despite not having a better pain control, the TAP block enabled a lower opioid consumption during the intraoperative period. Since opioid’s immunosuppressive role is well established, these results may bring to light an alternative and effective approach to oncologic patients. Nonetheless, larger size prospective studies are required to better clarify the long-term impact of lowering opioid consumption during the intra-operative period.


09 / Transversus abdominis plane block for radical prostatectomy