Comparison between epidural technique and mid-axillary ultrasound-guided TAP block for postoperative analgesia of laparoscopic radical prostatectomy: a quasi-randomized clinical trial
Comparação entre técnica peridural e bloqueio PTA guiado por ultrassom axilar médio para analgesia pós-operatória de prostatectomia radical laparoscópica: um ensaio clínico quase randomizado
Ana Tejedor, Carme Deiros, Marta García, Marina Vendrell, Nuria Gómez, Esther Gómez, Josep Masdeu
Abstract
Background
Our goal was to evaluate whether TAP block offers the same analgesic pain control compared to epidural technique in laparoscopic radical prostatectomy surgery through the morphine consumption in the first 48 hours.
Methods
In this study, 45 patients were recruited and assigned to either TAP or epidural. The main study outcome was morphine consumption during the first 48 hours after surgery. Other data recorded were pain at rest and upon movement, technique-related complications and adverse effects, surgical and postoperative complications, length of surgery, need for rescue analgesia, postoperative nausea and vomiting, start of intake, sitting and perambulation, first flatus, and length of in-hospital stay.
Results
From a total of 45 patients, two were excluded due to reconversion to open surgery (TAP group = 20; epidural group = 23). There were no differences in morphine consumption (0.96 vs. 0.8 mg; p = 0.78); mean postoperative VAS pain scores at rest (0.7 vs. 0.5; p = 0.72); or upon movement (1.6 vs. 1.6; p = 0.32); in the TAP vs. epidural group, respectively. Sitting and perambulation began sooner in TAP group (19 vs. 22 hours, p = 0.03; 23 vs. 32 hours, p = 0.01; respectively). The epidural group had more technique-related adverse effects.
Conclusion
TAP blocks provide the same analgesic quality with optimal pain control than epidural technique, with less adverse effects.
Keywords
Resumo
Justificativa: Nosso objetivo foi avaliar se o bloqueio PTA oferece o mesmo controle analgésico da dor em comparação à técnica peridural na cirurgia de prostatectomia radical laparoscópica através do consumo de morfina nas primeiras 48 horas. Métodos: Neste estudo, 45 pacientes foram recrutados e designados para PTA ou epidural. O principal desfecho do estudo foi o consumo de morfina durante as primeiras 48 horas após a cirurgia. Outros dados registrados foram dor em repouso e em movimento, complicações relacionadas à técnica e efeitos adversos, complicações cirúrgicas e pós-operatórias, tempo de cirurgia, necessidade de analgesia de resgate, náuseas e vômitos pós-operatórios, início da ingestão, sentar e deambulação, primeiros flatos e tempo de internação hospitalar. Resultados: De um total de 45 pacientes, dois foram excluídos por reconversão para cirurgia aberta (grupo PTA = 20; grupo Epidural = 23). Não houve diferenças no consumo de morfina (0,96 vs. 0,8 mg; p = 0,78); escores médios de dor pós-operatória da VAS em repouso (0,7 vs. 0,5; p = 0,72); ou em movimento (1,6 vs. 1,6; p = 0,32); no grupo PTA vs. peridural, respectivamente. Sentado e deambulação começaram mais cedo no grupo TAP (19 vs. 22 horas, p = 0,03; 23 vs. 32 horas, p = 0,01; respectivamente). O grupo epidural teve mais efeitos adversos relacionados à técnica. Conclusão: Os bloqueios TAP proporcionam a mesma qualidade analgésica com controle ideal da dor que a técnica epidural, com menos efeitos adversos.
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References
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