Postoperative analgesic effects of combined transversus abdominis plane block and anterior approach of sacral plexus block in patients undergoing laparoscopic radical prostatectomy: A randomized controlled trial.

STUDY OBJECTIVE: This study aimed to evaluate the efficacy of the combination of ultrasound-guided transversus abdominis plane block (TAPB) and a novel anterior approach of sacral plexus block (SPB) on postoperative pain following laparoscopic radical prostatectomy.

DESIGN: Double-blinded, prospective, randomized study.

SETTING: University-affiliated tertiary care hospital.

PATIENTS: Ninety patients aged 40 to 80 years with American Society of Anesthesiologists (ASA) physical status of I-III scheduled to undergo elective laparoscopic radical prostatectomy under general anesthesia.

INTERVENTIONS: Patients were randomized to receive TAPB alone (Control group) or the combination of TAPB and anterior approach of SPB (SPB group).

MEASUREMENTS: The primary outcome was cumulative intravenous morphine equivalent consumption at 24 h postoperatively. Secondary outcomes included pain scores, the incidence and severity of catheter-related bladder discomfort, patient satisfaction for analgesia, rescue analgesia requirement, time to first patient-controlled analgesia (PCA) demand, the incidence of side effects, and clinical recovery.

MAIN RESULTS: The median (interquartile range [IQR]) intravenous morphine equivalent was 28 (24, 30) mg in the SPB group compared with the control group, which had a median (IQR) of 34 (30, 41) mg. The median difference of -6 (95 % confidence interval, -8 to -4, P<0.001) was statistically different but not clinically important. The incidence of catheter-related bladder discomfort at 1 h, 4 h and 8 h after surgery were significantly lower in the SPB group. The SPB decreased the pain scores at 1 h postoperatively, prolonged the time to first PCA demand, and increased the Quality of Recovery-15 score at 48 h postoperatively. No significant differences were observed in satisfaction scores, the requirement for rescue analgesia, time to first flatus and ambulation, and the incidence of adverse effects.

CONCLUSIONS: The addition of the anterior approach of SPB was not superior to TAPB alone in reducing opioid consumption for laparoscopic radical prostatectomy. However, it was associated with lower early postoperative pain scores, decreased incidence of catheter-related bladder discomfort, and improved quality of recovery.