Postoperative Pain Control for Prostatectomy (TAP)

The researchers propose to investigate a relatively new anesthetic procedure, in order to maximize patient comfort and minimize the use of narcotics after a radical prostatectomy.

Our current post operative analgesic strategy involves a multi-modal approach, using local injectable anesthetic around the incision and systemic medications (i.e. non-steroidal anti-inflammatories, acetaminophen and break-through doses of opiates). As the amount of opiates used can be significant, we have to be aware of their inherent risks. Opiates have an excellent pain control profile, working peripherally by decreasing the amount of neurotransmitters released from neurons involving noxious stimuli, and also in their central processing. Some of the more common adverse reactions are reparatory depression, sedation, confusion, delirium, nausea, pruritis, constipation, hypotension and bradycardia. Often it is these resulting side effects that extend the length of in hospital rehabilitation, and decrease a patient's overall satisfaction.

Thus we propose the use of a relatively new regional anesthetic technique be employed to further decrease the need for opiates in our prostatectomy patients' post-op course, while adequately controlling their pain.

• Procedure: Transverse Abdominal Plan (TAP)
  An injectable anesthetic is introduced to a specific anatomic area where the sensory neurons supplying the operative field.
  Other Names:

  • lidocaine
  • ropivacaine
• Procedure: standard post op pain control
  opiates
  Other Name: timed assessments for pain and medications

• Experimental: TAP arm
  in the experimental arm, the procedure will consist of the staff urologist injecting local anesthetic into the anterior abdominal wall bilaterally from the inside of the abdomen at the end of their surgery
  Intervention: Procedure: Transverse Abdominal Plan (TAP)
• Active Comparator: standard post operative pain control
  Our current post operative analgesic strategy involves a multi-modal approach, using local injectable anesthetic around the incision and systemic medications (i.e. non-steroidal anti-inflammatories, acetaminophen and break-through doses of opiates). Some of the more common adverse reactions are reparatory depression, sedation, confusion, delirium, nausea, pruritis, constipation, hypotension and bradycardia. Often it is these resulting side effects that extend the length of in hospital rehabilitation, and decrease a patient's overall satisfaction.
  Intervention: Procedure: standard post op pain control

Inclusion Criteria:

• prostate cancer for radical prostatectomy

Exclusion Criteria:

• chronic pain or opiate use