Ultrasound-guided Transversus Abdominis Plane Block is Effective as Laparoscopic Trocar site infiltration in Postoperative Pain Management in Patients Undergoing Adrenal Surgery

Author:

Cavallaro Giuseppe1ORCID,Gazzanelli Sergio1,Iossa Angelo2,De Angelis Francesco2,Fassari Alessia1,Micalizzi Alessandra2,Petramala Luigi3,Crocetti Daniele1,Circosta Francesco3,Concistrè Antonio3,Letizia Claudio3,De Toma Giorgio1,Polistena Andrea1

Affiliation:

1. Department of Surgery “P. Valdoni”, Sapienza University, Rome, Italy

2. Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy

3. Department of Translational and Precision Medicine, Sapienza University, Rome, Italy

Abstract

Background Pain management in patients undergoing laparoscopy is still a matter of debate as several techniques have been proposed to reduce postoperative analgesic consumption and improve recovery. Among these, transversus abdominis plane (TAP) block is considered as safe, effective, and easy to perform under ultrasound guidance; even so, recently laparoscopically guided trocar site anesthetic infiltration has been proposed as a “surgeon-dependent alternative to TAP block.” The aim of this evaluation is to compare these analgesic techniques in the setting of laparoscopic adrenalectomy. Methods This is a retrospective evaluation of a prospectively maintained database. Patients were divided into two groups: Group A patients received laparoscopic-assisted trocar site infiltration of ropivacaine; Group B patients received bilateral ultrasound-guided TAP block with ropivacaine. All patients received 24 h infusion of 20 mg morphine postoperatively; pain was checked at 6, 24 and 48 h after surgery. A rescue analgesia was given if numerical rating scale (NRS) score was > 4 or on patient request. Results One hundred and three patients were enrolled in the evaluation (57 in group A and 46 in group B). There were no differences in operative time, complications and postoperative stay, and no complications related to trocar site infiltration. There were no differences in NRS at 6, 24, and 48 hours as well as in patients requiring further analgesic administration. Conclusions Laparoscopic-guided trocar site ropivacaine infiltration has similar pain outcomes compared to ultrasound-guided TAP block in the management of postoperative pain in patients undergoing laparoscopic adrenalectomy. Since there is no difference among these techniques, the decision can be based on surgeon or anesthesiologist preference.

Publisher

SAGE Publications

Subject

General Medicine

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