title: Transversus abdominis plane block or subcutaneous wound infiltration after open radical prostatectomy: a randomized study.
abstract: BACKGROUND
  Open radical retropubic prostatectomy (ORRP) is associated with moderate pain. We hypothesized that a transversus abdominis plane (TAP) block would reduce post-operative pain, morphine consumption and opioid-related side effects compared with wound infiltration and placebo in this population.
  
  
  METHODS
  This was a randomized, double-blind and placebo-controlled study. The operations were performed with patients in general anaesthesia. Patients were allocated to receive either bilateral TAP block (n = 23), wound infiltration (n = 25) or placebo (n = 25). Treatment was 40 ml ropivacaine 0.75% and placebo was 40 ml saline 0.9%. Pre-operatively, all patients received oral gabapentin, ibuprofen and paracetamol, followed by oral paracetamol and ibuprofen at regular doses and intervals, and patient-controlled analgesia with IV morphine from 0 h to 24 h post-operatively.
  
  
  RESULTS
  Visual analogue scale pain score during mobilization 4 h post-operatively (primary outcome) did not differ significantly between the TAP block and placebo group (TAP 28 ± 22 mm vs. placebo 33 ± 18 mm, P = 0.64). Pain scores (as area under the curve) during the first 24 h were not significantly different among any of the three groups, neither at rest nor during mobilization. Morphine consumption (0-24 h) did not differ significantly between groups {TAP block = 15 [8-23] mg, infiltration 15 [8-36] mg, placebo 15 [3-30] mg, [median (interquartile range)]}. Levels of nausea, sedation and number of vomits were not different among the groups.
  
  
  CONCLUSIONS
  Neither TAP block nor wound infiltration with ropivacaine improved a basic multimodal analgesic regimen with paracetamol, ibuprofen and gabapentin after ORRP.
authors: Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. askjelsager@gmail.com
authors: A
authors: A
authors: Skjelsager
authors: B
authors: B
authors: Ruhnau
authors: T K
authors: TK
authors: Kistorp
authors: I
authors: I
authors: Kridina
authors: H
authors: H
authors: Hvarness
authors: O
authors: O
authors: Mathiesen
authors: J B
authors: JB
authors: Dahl
mesh_terms: D000009:Abdominal Muscles / Q000294:innervation; D000328:Adult; D000368:Aged; D000577:Amides / Q000008:administration & dosage*; D016058:Analgesia, Patient-Controlled; D000779:Anesthetics, Local / Q000008:administration & dosage*; D004311:Double-Blind Method; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000517:prevention & control*; D011468:Prostatectomy / Q000379:methods*; D000077212:Ropivacaine
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D009020:Morphine; D000077212:Ropivacaine