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Bilateral transversus abdominis plane and rectus sheath blocks with liposomal bupivacaine for patients undergoing robotic prostatectomy

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Abstract

As robotic prostatectomy surgery becomes more prevalent, it is important to identify any regional techniques to optimize patient's recovery. We evaluated the effectiveness of bilateral transversus abdominis plane (TAP) and rectus sheath (RS) blocks with liposomal bupivacaine. We hypothesized that these blocks would reduce perioperative opioid use and pain scores. A retrospective cohort of patients from May 2018 and May 2021 at a single large VA hospital were studied. We compared those not receiving a nerve block against those receiving the TAP and RS as part of an Enhanced Recovery After Surgery (ERAS) pathway starting in May 2019. The primary outcome was post-operative opioid use. Secondary outcomes were post-operative pain scores and hospital length of stay. One hundred and thirty-four patients were included in the final analysis. Eighty-one patients did not receive a block and fifty-three patients did receive a block. No difference existed between the groups in regard to median oral morphine equivalents (mg) used in PACU or any post-operative day. No difference existed in median opioid usage (mg) or pain scores between the two groups on any post-operative day. There was no difference in temporal association of median pain scores or narcotic usage between the two groups. Bilateral TAP and RS with liposomal bupivacaine did not significantly decrease post-operative opioid use, improve pain scores, or decrease hospital length of stay for patients undergoing robotic prostatectomy. Further studies need to be done to evaluate the effect of these blocks with liposomal bupivacaine.

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Data availability

Data will not be made available given this study took place at a Veterans Affairs Hospital.

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Acknowledgements

The authors thank Christina Johnson, PA for help with coordinating this study.

Funding

This work was supported by an award (author M.K.) from the Small Award Initiative for Impact-Independent VA Investigators (SWIFT-IVI) Voucher Program, United States Department of Veterans Affairs (no grant number available).

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Authors and Affiliations

  1. Department of Anesthesiology, Hunter Holmes McGuire VA Medical, 1201 Broad Rock Blvd, Richmond, VA, 23249, USA

    Michael R. Kazior

  2. Department of Anesthesiology, Virginia Commonwealth University Medical Center, 1200 E. Broad St, 7th Floor, North Wing, PO Box 980695, Richmond, VA, 23298, USA

    Michael R. Kazior

  3. Virginia Commonwealth University School of Medicine, 1201 E. Marshall St #4-100, Richmond, VA, 23298, USA

    Andrew Nguyen, Joshua Kang, Yasir Al-Dojaily & Brian Coyne

  4. Department of Biostatistics, Virginia Commonwealth University School of Medicine, PO Box 980032, Richmond, VA, 23298, USA

    Nitai Mukhopadhyay

  5. Department of Surgery, Division of Urology, Virginia Commonwealth University Medical Center, 1200 E. Broad St, 16th Floor, West Wing, PO Box 980645, Richmond, VA, 23298, USA

    Lance Hampton

  6. Department of Surgery, Division of Urology, Hunter Holmes McGuire VA Medical Center, 1201 Broad Rock Blvd, Richmond, VA, 23249, USA

    Lance Hampton

Authors
  1. Michael R. Kazior
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  2. Andrew Nguyen
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  3. Joshua Kang
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  4. Yasir Al-Dojaily
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  6. Nitai Mukhopadhyay
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  7. Lance Hampton
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Contributions

MK—Study design, data collection, data analysis, writing of manuscript, approval. AN, JK, YA, BC—Data collection, writing of manuscript, approval. NM—data analysis, writing of manuscript, approval. LH—writing of manuscript, approval.

Corresponding author

Correspondence to Michael R. Kazior.

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Conflict of interest

The authors declare they have no competing interests and have no relevant financial or non-financial interests to disclose.

Ethical approval and consent

This study was performed in line with the principles of the Declaration of Helsinki. Approved by the Institutional Review Board of Central Virginia Healthcare System (study number 1602982-6). All methods were carried out in accordance with relevant guidelines and regulations. Given this is a retrospective study, a waiver of informed consent was obtained for this study.

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Kazior, M.R., Nguyen, A., Kang, J. et al. Bilateral transversus abdominis plane and rectus sheath blocks with liposomal bupivacaine for patients undergoing robotic prostatectomy. J Robotic Surg 17, 1817–1823 (2023). https://doi.org/10.1007/s11701-023-01598-8

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  • DOI: https://doi.org/10.1007/s11701-023-01598-8

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