Opioid-free anesthesia in robotic prostatectomy: pain management without transversus abdominis plane block

摘要

BACKGROUND: Transversus abdominis plane (TAP) block is a common analgesic technique in robotic-assisted laparoscopic radical prostatectomy (RALP). However, its necessity in the framework of an opioid-free anesthesia (OFA) strategy has not yet been evaluated. Our aim was to assess if TAP block is essential for optimal pain management under OFA strategy in RALP. METHODS: A retrospective quasi-experimental study was conducted involving 40 adult patients undergoing RALP between March 2024 and March 2025. All patients received an OFA strategy (continuous intravenous [IV] infusion of lidocaine, dexmedetomidine, and ketamine). Both groups followed the same postoperative multimodal analgesic protocol. The primary outcome was perioperative opioid requirements from the start of surgery until 48 hours postoperatively (expressed as IV milligram morphine equivalents [MME]). Secondary outcomes were Numerical Rating Scale (NRS) scores, start to sitting and ambulation, postoperative complications and length of hospital stay. RESULTS: Of 40 patients, 17 (42.5%) patients underwent ultrasound-guided TAP block (TAP group -control group-), while 23(57.5%) did not (non-TAP group). Perioperative opioid requirements were similar and extremely low (TAP and non-TAP group: median 0 (IQR:0-0) IV MME; P=0.962), as well as NRS scores (median ≤ 1) at 1, 2, 4, 6, 12, 18, 24 and 48 h (P>0.05). Multivariate analysis showed no independent association between perioperative IV MME and TAP block (median difference -0.1, 95% CI: -0.6 to 0.5, P=0.741). Start to sitting and ambulation, postoperative complications or length of hospital-stay did not show statistical differences. CONCLUSIONS: In our single-center study, when extraperitoneal RALP was performed, the TAP block under OFA strategy did not offer clinical analgesic benefit.