Rectus Sheath Block May Relieve Urethral Catheter Pain
Condition: Prostatectomy
Study type: Interventional

Summary: 
      This study aimed to investigate the analgesic efficacy of rectus sheath block and its effect
      on urethral catheter discomfort in robotic prostatectomy operations.
    

Detailed description: 
      Our study will be performed on patients who will undergo elective robotic prostatectomy at
      the American Hospital and Koc University Hospital.All patients will be sedated with midazolam
      (0.02 mg/kg), following appropriate ASA monitoring and administration of oxygen by mask. All
      patients will be operated on under general anesthesia. Propofol (Propofol-Lipuro 10mg/ml,
      Braun) (2 mg/kg), fentanyl (Talinat 0.5mg, Vem İlaç) (0.8µg/kg) and rocuronium (Esmeron
      10mg/ml) for the induction of general anesthesia following appropriate monitoring. Following
      the administration of MSD) (0.6 mg/kg), endotracheal intubation will be performed. For the
      maintenance of anesthesia, desflurane (Suprane, Baxter) (1 MAC) and remifentanil (Rentanil
      2mg, Vem İlaç) (0.05 - 0.2 µg/kg/min) will be administered. Invasive monitoring will be
      performed on all patients through the radial artery cannula. Depth of anesthesia will be
      monitored with BIS (Bispectral Index Monitor), and BIS values will be adjusted to be 40-60.
      In all patients, dexamethasone (Onadron 8mg/2ml, İbrahim Etem) (4mg), ibuprofen 800mg
      (Intrafen 400mg, Gen İlaç) immediately after intubation and intravenous Paracetamol 1000mg
      (Parol, Atabay Kimya Sanayi) and Tramadol before extubation to contribute to postoperative
      analgesia 100 mg (Contramal, Abdi İbrahim İlaç Sanayi) will be administered. In addition,
      ondansetron (Zofer 4mg, Adeka) (4mg) will be administered for postoperative nausea and
      vomiting (PONV) prophylaxis.

      A rectus sheath block will be applied to one group by randomization in the computer
      environment, and a fascial plane block will be applied to the other group. At the end of the
      operation, the anesthesiologist was dressed sterile before the extubation. Surgical drapes
      and blocks were applied in the supine position without disturbing the sterile environment.
      Ultrasound and liner probe was covered with a sterile drape. Rectus block, wide bandwidth,
      high-frequency linear probe (4-12 Mhz) (GE, LOGIQ P9 R3, Seongnam-si, Republic of Korea) and
      22 Gauge, 80 mm, insulated facet needle (Pajunk GmbH, Geisingen, Germany) ) was planned. For
      the rectus sheath block (RB), the ultrasound probe is placed transversely at the level of the
      umbilicus. The rectus abdominis muscle and fascia transversalis are displayed. The needle is
      placed on the ultrasound probe from the lateral to the medial by in-plane technique and
      placed between the posterior sheath of the rectus muscle and the fascia transversalis. 20 ml
      of 0.25% Bupivacaine plaine (MArcaine, Sanofi İlaç A.Ş, Turkey) is administered after the
      fascial spread is observed under the rectus abdominis muscle using the hydro dissection
      technique with saline. For RB, the same procedure is applied to the other parties.

      After the patients are extubated, they will be taken to the recovery unit and followed up at
      0,10,30, and 60 minutes in pain scores, nausea, vomiting, and other side effects. The pain
      scores (postoperative pain and urethral catheter-related pain) of the patients transferred
      from the recovery unit to the service floor will be recorded at the 3rd hour, 6th hour, 12th
      hour, and 24th hour. To contribute to multimodal analgesia in service follow-ups, intravenous
      Paracetamol 1000 mg (Parol, Atabay Kimya Sanayi) 3*1 and ibuprofen (Intrafen 400mg, Gene
      İlaç) 2x400mg will be administered.

      Recovery unit (PACU) follow-up; Pain scores of all patients will be recorded at 0, 30, and 60
      minutes by blind nurses for the study groups. Patients with NRS scores ≥ 4 will receive 25 µg
      of fentanyl. Patients with NRS scores ≥ 7 will receive 50 µg of fentanyl. Once NRS scores
      continue as indicated, fentanyl will be repeated at the same dose at relevant times. The
      total fentanyl dose requirement in the PACU will be recorded. The PACU unit will record side
      effects such as nausea, difficulty breathing, and tremors. Urethral catheter pain will also
      be questioned and recorded at the relevant specified times in the PACU unit. Intravenous
      morphine patient-controlled analgesia (PCA) will be started in all patients. PCA doses will
      be adjusted for all patients with only a bolus dose of 1 mg with a 7 min lock time. PCA bolus
      dose used during the PACU period will be recorded. Patients will be given pain score
      information for PCA use and instructed to press the bolus button if their pain is four or
      more.
    

Intervention name(s): Robotic prostatectomy
Intervention type(s): Procedure
Intervention description(s): patients who will undergo robotic prostatectomy
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Primary purpose: Other
Keywords: regional anesthesia; robotic prostatectomy; fascial plane blocks; postoperative pain; urethral catheter pain