1
|
Maurer J, Friedemann T, Chen Y, Ambrosini F, Knipper S, Maurer T, Heinzer H, Thederan I, Schroeder S. A randomized controlled study on acupuncture for peri-operative pain after open radical prostatectomy. BJU Int 2024; 133:725-732. [PMID: 38316611 DOI: 10.1111/bju.16288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
OBJECTIVES To evaluate the advantages of adding acupuncture to standard postoperative pain management for open radical prostatectomy (RP). MATERIALS AND METHODS A randomized controlled trial (1:1:1) comparing routine postoperative analgesic care (control [CON]) vs the addition of press tack needle acupuncture (ACU) or press tack placebo acupressure (SHAM) for pain management after open RP was performed. A total of 126 patients were enrolled between February 2020 and April 2021. After open RP, the CON group received standard postoperative analgesia, the ACU group received long-term acupuncture with press tacks at specific points (P-6, Shenmen and SP-6) along with standard analgesia, and the SHAM group received placebo press tacks at the same acupuncture points alongside standard analgesia. The primary endpoint was postoperative pain measured on a numeric rating scale, the NRS-11, calculated as the area under the curve. The cumulative use of routine postoperative analgesics, time to first defaecation, and quality of life were analysed using the Kruskal-Wallis rank sum test, Fisher's exact test, and Pearson's chi-squared test. RESULTS The ACU group reported significantly less postoperative pain compared to the SHAM (P = 0.007) and CON groups (P = 0.02). There were no significant difference in median (interquartile range) cumulative pain medication usage, time to first defaecation (CON: 37 [33, 44] h; SHAM: 37 [33, 42] h; ACU: 37 [33, 41] h; P > 0.9), or health status at discharge (EuroQol five-dimension, five-level general health assessment questionnaire: CON: 70 [65-83]; SHAM: 70 [60-80]; ACU: 70 [50-80]). CONCLUSION Incorporating acupuncture into postoperative pain management can improve patient postoperative outcomes.
Collapse
Affiliation(s)
- Jean Maurer
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Friedemann
- HanseMerkur Center for Traditional Chinese Medicine at the University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Yuelai Chen
- Longhua Hospital Affiliated to Shanghai University of TCM, Shanghai, China
| | - Francesca Ambrosini
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Sophie Knipper
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias Maurer
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Hans Heinzer
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Imke Thederan
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Sven Schroeder
- HanseMerkur Center for Traditional Chinese Medicine at the University Hospital Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
2
|
Yang M, Cao L, Lu T, Xiao C, Wu Z, Jiang X, Wang W, Li H. Ultrasound-guided erector spinae plane block for perioperative analgesia in patients undergoing laparoscopic nephrectomy surgery: A randomized controlled trial. Heliyon 2024; 10:e26422. [PMID: 38434013 PMCID: PMC10906293 DOI: 10.1016/j.heliyon.2024.e26422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 03/05/2024] Open
Abstract
Study objective Kidney neoplasms have a high incidence, and radical nephrectomy or partial nephrectomy are the main treatment options. Our study aims to investigate the use of ultrasound-guided erector spinae plane block for perioperative analgesia in patients undergoing laparoscopic nephrectomy surgery. Design Prospective, randomized, double-blind. Setting University hospital. Patients Our study included 50 patients (ASA I-III) who underwent laparoscopic nephrectomy at the hospital of Second Affiliated Hospital of Army Medical University. Interventions The patients were divided into two groups: the ESPB group and the control group. In the ESPB group, a mixture of 10 mL of 1% lidocaine, 10 mL of 0.7% ropivacaine, 0.5 μg/kg dexmedetomidine, and 5 mg of dexamethasone was administered. In the control group, 20 mL of 0.9% saline was administered. Measurements The primary outcome measure was the total consumption of sufentanil during the intraoperative period. Secondary outcome measures included visual analogue scale (VAS) pain scores at rest and during coughing at 1 h, 6 h, 12 h, 24 h, and 48 h postoperatively, intraoperative consumption of remifentanil, frequency of rescue analgesic administration, consumption of rescue analgesia and incidence of postoperative nausea and vomiting within 48 h. Results The ESPB group exhibited lower intraoperative consumption of sufentanil, lower consumption of rescue analgesia, as well as VAS scores at rest and during coughing within the first 24 h postoperatively, compared to the control group. However, no significant differences were observed in VAS scores at 48 h postoperatively, postoperative nausea and vomiting, or the need for postoperative rescue analgesia. Conclusions Ultrasound-guided ESPB performed in patients who underwent laparoscopic nephrectomy demonstrated a substantial decrease in intraoperative opioid consumption, as well as lower VAS scores at rest and during coughing in the postoperative period.
Collapse
Affiliation(s)
- Ming Yang
- Department of Anesthesiology, Xinqiao Hospital of Chongqing, Second Affiliated Hospital of Army Medical University, PLA, Chongqing, 400037, China
| | - Lei Cao
- Department of Anesthesiology, Xinqiao Hospital of Chongqing, Second Affiliated Hospital of Army Medical University, PLA, Chongqing, 400037, China
| | - Tong Lu
- Department of Anesthesiology, Xinqiao Hospital of Chongqing, Second Affiliated Hospital of Army Medical University, PLA, Chongqing, 400037, China
| | - Cheng Xiao
- Department of Anesthesiology, Xinqiao Hospital of Chongqing, Second Affiliated Hospital of Army Medical University, PLA, Chongqing, 400037, China
| | - Zhuoxi Wu
- Department of Anesthesiology, Xinqiao Hospital of Chongqing, Second Affiliated Hospital of Army Medical University, PLA, Chongqing, 400037, China
| | - Xuetao Jiang
- Department of Anesthesiology, Xinqiao Hospital of Chongqing, Second Affiliated Hospital of Army Medical University, PLA, Chongqing, 400037, China
| | - Wei Wang
- Department of Anesthesiology, Xinqiao Hospital of Chongqing, Second Affiliated Hospital of Army Medical University, PLA, Chongqing, 400037, China
| | - Hong Li
- Department of Anesthesiology, Xinqiao Hospital of Chongqing, Second Affiliated Hospital of Army Medical University, PLA, Chongqing, 400037, China
| |
Collapse
|
3
|
Kurzova A, Malek J, Klezl P, Hess L, Sliva J. A Single Dose of Intrathecal Morphine Without Local Anesthetic Provides Long-Lasting Postoperative Analgesia After Radical Prostatectomy and Nephrectomy. J Perianesth Nurs 2024:S1089-9472(23)01029-8. [PMID: 38300193 DOI: 10.1016/j.jopan.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/27/2023] [Accepted: 10/28/2023] [Indexed: 02/02/2024]
Abstract
PURPOSE Pain after open urological procedures is often intense. The aim of the study was to compare the efficacy of intrathecal morphine with systemic analgesia approaches. DESIGN Prospective, randomized, single-blind controlled study. METHODS Patients undergoing open prostatectomy or nephrectomy were randomly divided into the intervention group or the control group. Patients in the intervention group received morphine 250 mcg in 2.5 mL saline intrathecally. Anesthesia was identical in both groups. All patients were admitted to the intensive care unit (ICU) postoperative and received paracetamol 1 g intravenously every 6 hours and diclofenac 75 mg intramuscularly every 12 hours. If postoperative pain exceeded four on the numeric rating scale, morphine 10 mg was administered subcutaneously. Pain intensity, time to first dose of morphine, morphine doses, and side effects were recorded. FINDINGS In total, 41 patients were assigned to the intervention group and 57 to the control group. The time to administration of the first dose of morphine was significantly (P < .001) longer in the intervention group when compared to controls. This observation was also noted individually for patients undergoing nephrectomy (36.86 hours vs 4.06 hours) and prostatectomy (33.13 hours vs 4.5 hours). Many patients did not need opioids after surgery in the intervention group (nephrectomy 72% vs 3%, prostatectomy 75% vs 4.5%, P < .001). There was no significant difference in the incidence of side effects. CONCLUSIONS The results of our study confirmed that preoperative intrathecal morphine provides long-lasting analgesia and reduces the need for postoperative systemic administration of opioids. Adverse effects are minor and comparable between groups.
Collapse
Affiliation(s)
- Alice Kurzova
- Department of Anesthesia and Intensive Care Medicine, Third Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital, Prague, Czech Republic
| | - Jiri Malek
- Department of Anesthesia and Intensive Care Medicine, Third Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital, Prague, Czech Republic
| | - Petr Klezl
- Department of Urology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Ladislav Hess
- Department of Laboratory of Experimental Anesthesiology, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jiri Sliva
- Department of Pharmacology, Third Faculty of Medicine, Charles University, Prague, Czech Republic.
| |
Collapse
|
4
|
Spirito L, Marra A, Mirone V, Manfredi C, Fusco F, Napolitano L, Servillo G, Lo Grieco N, Buonanno P. Role of spinal anesthesia in robot-assisted radical prostatectomy: Gamble or opportunity? Arch Ital Urol Androl 2023. [PMID: 37278379 DOI: 10.4081/aiua.2023.11311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 03/23/2023] [Indexed: 06/07/2023] Open
Abstract
To the Editor, Although postoperative pain associated with robot-assisted radical prostatectomy (RARP) is less than pain following the open technique, it remains a fundamental issue as it can be a significant source of discomfort for the patient and lengthen recovery times after surgery. The optimal management of pain after RARP is far from being fully elucidated and many factors have to be evaluated to choose the best analgesic approach. [...].
Collapse
Affiliation(s)
- Lorenzo Spirito
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples.
| | - Annachiara Marra
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples.
| | - Vincenzo Mirone
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples.
| | - Celeste Manfredi
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples.
| | - Ferdinando Fusco
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples.
| | - Luigi Napolitano
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples.
| | - Giuseppe Servillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples.
| | - Nicola Lo Grieco
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples.
| | - Pasquale Buonanno
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples.
| |
Collapse
|
5
|
An analysis of post-operative pain and narcotic use following robotic assisted laparoscopic prostatectomy for same day discharge. J Robot Surg 2023; 17:37-42. [PMID: 35294700 DOI: 10.1007/s11701-022-01386-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 02/06/2022] [Indexed: 12/24/2022]
Abstract
Robotic assisted laparoscopic prostatectomy (RALP) has become the primary surgical modality in the treatment of prostate cancer. Most patients are discharged on postoperative day one. Same-day discharge is emerging as a potential new standard. We sought to establish factors correlating with post-operative pain after RALP procedures to design a same-day discharge protocol. We retrospectively reviewed 150 of recently performed RALP procedures from March 2020 to January 2021. Patient demographics and intra-operative variables were compared to Numeric Rating Scale (NRS) pain scores and total morphine milliequivalents (MME) at 2 h, 8 h, and averaged over the patient's admission post-operatively or first 48 h, whichever occurred first. We performed univariable and multivariable logistic regression to assess correlations with postoperative pain and narcotic use. NRS average > 3 or any MME given at 2 h postoperatively was significantly associated with continued post-operative pain averaged over admission (rs = 0.32, 0.38, respectively; p < 0.001). MME given was also associated with longer operative time and negative related to body mass index. No other demographic data or intraoperative variables such as diabetes or pneumoperitoneum pressure were correlated with worsened post-operative pain scores > 3 or narcotic use. Local bupivacaine dose was also not associated with improved post-operative pain scores or narcotic use at 8 h (p = 0.98, 0.13). These findings suggest that patients with adequate postoperative pain control at 2 hours may be discharged same day from a pain control perspective. Further clinical evaluation regarding the role of local anesthetic use in RALPs is warranted.
Collapse
|
6
|
Turcotte B, Jacques E, Tremblay S, Toren P, Caumartin Y, Lodde M. Opioid use after uro-oncologic surgeries in time of opioid crisis. Can Urol Assoc J 2022; 16:E432-E436. [PMID: 35302470 PMCID: PMC9343155 DOI: 10.5489/cuaj.7633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
INTRODUCTION Recent literature emphasizes how overprescription and lack of guidelines contribute to wide variation in opioid prescribing practices and opioid-related harms. We conducted a prospective, observational study to evaluate opioid prescriptions among uro-oncologic patients discharged following elective in-patient surgery. METHODS Patients who underwent four surgeries were included: open retropubic radical prostatectomy, robot-assisted radical prostatectomy, laparoscopic radical nephrectomy, and laparoscopic partial nephrectomy. The primary outcome was the dose of opioids used after discharge (in oral morphine equivalents [MEq]). Secondary outcomes included: opioid requirements for 80% of the patients, management of unused opioids, opioid use three months postoperative, opioid prescription refills, and guidance about opioid disposal. RESULTS Sixty patients were included for analysis. Patients used a mean of 30 MEq (95% confidence interval 17.8-42.2) at home and 80% of the patients used 50 MEq or less. A mean of 40.4 MEq per patient was overprescribed. Fifty percent of the patients kept the remaining opioids at home, with only 20.0% returning them to their pharmacy. After three months, 5.0% of the patients were using opioids at least occasionally. Three patients needed a new opioid prescription. Forty percent reported having received information regarding management of unused opioids. CONCLUSIONS We found 60% of opioids prescribed were unused, with half of our patients keeping these unused tablets at home. Our results suggest appropriate opioid prescription amounts needed for urological cancer surgery, with 80% of the patients using 50 MEq or less of morphine equivalents.
Collapse
Affiliation(s)
- Bruno Turcotte
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec, QC, Canada
| | - Emma Jacques
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec, QC, Canada
| | - Samuel Tremblay
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec, QC, Canada
| | - Paul Toren
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec, QC, Canada
| | - Yves Caumartin
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec, QC, Canada
| | - Michele Lodde
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec, QC, Canada
| |
Collapse
|
7
|
Su ZT, Becker REN, Huang MM, Biles MJ, Harris KT, Koo K, Han M, Pavlovich CP, Allaf ME, Herati AS, Patel HD. Patient and in-hospital predictors of post-discharge opioid utilization: Individualizing prescribing after radical prostatectomy based on the ORIOLES initiative. Urol Oncol 2021; 40:104.e9-104.e15. [PMID: 34857445 DOI: 10.1016/j.urolonc.2021.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/13/2021] [Accepted: 10/21/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Judicious opioid stewardship would match each patient's prescription to their true medical necessity. However, most prescribing paradigms apply preset quantities and clinical judgment without objective data to predict individual use. We evaluated individual patient and in-hospital parameters as predictors of post-discharge opioid utilization after radical prostatectomy (RP) to provide evidence-based guidance for individualized prescribing. METHODS A prospective cohort of patients who underwent open or robotic RP were followed in the Opioid Reduction Intervention for Open, Laparoscopic, and Endoscopic Surgery (ORIOLES) initiative. Baseline demographics, in-hospital parameters, and inpatient and post-discharge pain medication utilization were tabulated. Opioid medications were converted to oral morphine equivalents (OMEQ). Predictive factors for post-discharge opioid utilization were analyzed by univariable and multivariable linear regression, adjusting for opioid reduction interventions performed in ORIOLES. RESULTS Of 443 patients, 102 underwent open and 341 underwent robotic RP. The factors most strongly associated with post-discharge opioid utilization included inpatient opioid utilization in the final 12 hours before discharge (+39.6 post-discharge OMEQ if inpatient OMEQ was >15 vs. 0), maximum patient-reported pain score (range 0-10) in the 12 hours before discharge (+27.6 OMEQ for pain score ≥6 vs. ≤1), preoperative opioid use (+76.2 OMEQ), and body mass index (BMI; +1.4 OMEQ per 1 kg/m2). A final predictive calculator to guide post-discharge opioid prescribing was constructed. CONCLUSIONS Following RP, inpatient opioid use, patient-reported pain scores, prior opioid use, and BMI are correlated with post-discharge opioid utilization. These data can help guide individualized opioid prescribing to reduce risks of both overprescribing and underprescribing.
Collapse
Affiliation(s)
- Zhuo T Su
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Russell E N Becker
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mitchell M Huang
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Michael J Biles
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kelly T Harris
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kevin Koo
- Department of Urology, Mayo Clinic, Rochester, MN
| | - Misop Han
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christian P Pavlovich
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mohamad E Allaf
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Amin S Herati
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Hiten D Patel
- Department of Urology, Loyola University Medical Center, Maywood, IL
| |
Collapse
|
8
|
Masilamani MKS, Sukumar A, Cooke PW, Rangaswamy C. Role of multimodal anaesthetic in post-operative analgesic requirement for robotic assisted radical prostatectomy. Urologia 2021; 89:90-93. [PMID: 34338049 DOI: 10.1177/03915603211031869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Robotic assisted laparoscopic radical prostatectomy (RARP) is considered as standard of care for surgical management of localised prostate cancer. Procedure specific postoperative pain management (PROSPECT) guidelines are available for open radical prostatectomy. There is a lack of evidence for optimal pain management protocol in patients undergoing robotic radical prostatectomy. This study investigates the impact of multimodal anaesthetic on post-operative analgesic requirements. METHODS AND MATERIALS In our Institute, RARP is performed with a multimodal anaesthetic technique. Forty-one consecutive cases from October 2018 to March 2019 operated on by the same surgeon and anaesthetised by the same anaesthetic consultant were included in the study. All the patients received standardised multimodal anaesthetic technique. Data from visual analogue pain scores, nausea, vomiting and requirement of analgesics were collected from hospital records and results were analysed. RESULTS Our results showed that 60% of patients reported either no pain or mild pain. None of the patients required stronger opioids or parenteral analgesic. Only three patients required antiemetic. Length of hospital stay was 1.19 days which is comparable to published outcomes from high volume centres performing RARP. CONCLUSION Our study adds to the currently published literature that RARP when combined with the multimodal anaesthetic technique can significantly reduce stronger opioid analgesic requirement in the post-operative period without compromising LOS.
Collapse
|
9
|
PROSPECT guidelines update for evidence-based pain management after prostatectomy for cancer. Anaesth Crit Care Pain Med 2021; 40:100922. [PMID: 34197976 DOI: 10.1016/j.accpm.2021.100922] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 02/03/2023]
Abstract
The aim of this review was to update the recommendations for optimal pain management after open and laparoscopic or robotic prostatectomy. Optimal pain management is known to influence postoperative recovery, but patients undergoing open radical prostatectomy typically experience moderate dynamic pain in the immediate postoperative day. Robot-assisted and laparoscopic surgery may be associated with decreased pain levels as opposed to open surgery. We performed a systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) with PROcedure SPECific Postoperative Pain ManagemenT (PROSPECT) methodology. Randomised controlled trials (RCTs) published in English language, from January 2015 until March 2020, assessing postoperative pain, using analgesic, anaesthetic and surgical interventions, were identified from MEDLINE, EMBASE and Cochrane Databases. Of the 1797 studies identified, 35 RCTs and 3 meta-analyses met our inclusion criteria. NSAIDs and COX-2 selective inhibitors proved to lower postoperative pain scores. Continuous intravenous lidocaine reduced postoperative pain scores during open surgery. Local wound infiltration showed positive results in open surgery. Bilateral transversus abdominis plane (TAP) block was performed at the end of surgery and lowered pain scores in robot-assisted procedures, but results were conflicting for open procedures. Basic analgesia for prostatic surgery should include paracetamol and NSAIDs or COX-2 selective inhibitors. TAP block should be recommended as the first-choice regional analgesic technique for laparoscopic/robotic radical prostatectomy. Intravenous lidocaine should be considered for open surgeries.
Collapse
|
10
|
Kishikawa H, Suzuki N, Suzuki Y, Hamasaki T, Kondo Y, Sakamoto A. Effect of Robot-assisted Surgery on Anesthetic and Perioperative Management for Minimally Invasive Radical Prostatectomy under Combined General and Epidural Anesthesia. J NIPPON MED SCH 2021; 88:121-127. [PMID: 32475905 DOI: 10.1272/jnms.jnms.2021_88-304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Robot-assisted surgery and pure laparoscopic surgery are available for minimally invasive radical prostatectomy (MIRP). The differences in anesthetic management between these two MIRPs under combined general and epidural anesthesia (CGEA) remain unknown. This study therefore aimed to determine the effects of robot-assisted surgery on anesthetic and perioperative management for MIRP under CGEA. METHODS This retrospective observational study analyzed data from patients' electronic medical records. Data on demographics, intraoperative variables, postoperative complications, and hospital stays after MIRPs were compared between patients who underwent robot-assisted laparoscopic radical prostatectomy (RALP) and those treated by pure laparoscopic radical prostatectomy (LRP). RESULTS There were no differences in background data between the 102 who underwent RALP and 112 who underwent LRP. Anesthesia and surgical times were shorter in the RALP group than in the LRP group. Doses of anesthetics, including intravenous opioids, and epidural ropivacaine, were lower in the RALP group. Although estimated blood loss and volume of colloid infusion were lower in the RALP group, the volume of crystalloid infusion was larger. Intraoperative allogeneic transfusion was not required in either group. There was no difference between groups in the incidences of postoperative cardiopulmonary complications or postoperative nausea and vomiting. Hospital stays after the procedure were shorter in the RALP group. CONCLUSIONS Robot-assisted surgery required varied consumption of anesthetics and infusion management during MIRP under GCEA. It also shortened postoperative hospital stays, without increasing rates of postoperative complications.
Collapse
|
11
|
Dost B, Kaya C, Ozdemir E, Ustun YB, Koksal E, Bilgin S, Bostancı Y. Ultrasound-guided erector spinae plane block for postoperative analgesia in patients undergoing open radical prostatectomy: A randomized, placebo-controlled trial. J Clin Anesth 2021; 72:110277. [PMID: 33838536 DOI: 10.1016/j.jclinane.2021.110277] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE The aim of this study was to evaluate the effect of ultrasound-guided erector spinae plane (ESP) block on postoperative pain in radical prostatectomy, which leads to both visceral and somatic pain. DESIGN Prospective, randomized, placebo controlled, double-blinded. SETTING University hospital. PATIENTS A total of ASA I-III, 50 patients aged 18-65 who were scheduled for elective open radical prostatectomy surgery. INTERVENTIONS Patients were randomly allocated to receive an ultrasound-guided ESP block, with either local anesthetic (10 mL of 1% lidocaine +10 mL of 0.5% bupivacaine) or placebo bilaterally. MEASUREMENTS The primary outcome was morphine consumption in the first 24 h after surgery. The secondary outcomes were NRS pain scores at rest and coughing, intraoperative remifentanil consumption and need for rescue analgesic during the first 24 h after surgery. MAIN RESULTS Both NRS scores for post-anesthesia care unit and NRSrest scores for 1st hours were lower in Group ESPB (p < 0.001 and p = 0.033, respectively). Cumulative morphine consumption at 24 h post-surgery was similar between the groups (p = 0.447). Rescue analgesic requirement was higher in the placebo injection group than in the ESPB group at the 1st postoperative hour (p = 0.002). CONCLUSIONS In open radical prostatectomies, except for the first hour, ESP block is ineffective for pain scores and on morphine consumption compared to the placebo injection group in the postoperative period.
Collapse
Affiliation(s)
- Burhan Dost
- Department of Anaesthesiology and Reanimation, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey.
| | - Cengiz Kaya
- Department of Anaesthesiology and Reanimation, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Emine Ozdemir
- Department of Anaesthesiology and Reanimation, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Yasemin Burcu Ustun
- Department of Anaesthesiology and Reanimation, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Ersin Koksal
- Department of Anaesthesiology and Reanimation, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Sezgin Bilgin
- Department of Anaesthesiology and Reanimation, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Yakup Bostancı
- Department of Urology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| |
Collapse
|
12
|
Sisa K, Huoponen S, Ettala O, Antila H, Saari TI, Uusalo P. Effects of pre-emptive pregabalin and multimodal anesthesia on postoperative opioid requirements in patients undergoing robot-assisted laparoscopic prostatectomy. BMC Urol 2021; 21:14. [PMID: 33530959 PMCID: PMC7856812 DOI: 10.1186/s12894-021-00785-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 01/26/2021] [Indexed: 12/24/2022] Open
Abstract
Background Previous findings indicate that pre-emptive pregabalin as part of multimodal anesthesia reduces opioid requirements compared to conventional anesthesia in patients undergoing robot-assisted laparoscopic prostatectomy (RALP). However, recent studies show contradictory evidence suggesting that pregabalin does not reduce postoperative pain or opioid consumption after surgeries. We conducted a register-based analysis on RALP patients treated over a 5-year period to evaluate postoperative opioid consumption between two multimodal anesthesia protocols. Methods We retrospectively evaluated patients undergoing RALP between years 2015 and 2019. Patients with American Society of Anesthesiologists status 1–3, age between 30 and 80 years and treated with standard multimodal anesthesia were included in the study. Pregabalin (PG) group received 150 mg of oral pregabalin as premedication before anesthesia induction, while the control (CTRL) group was treated conventionally. Postoperative opioid requirements were calculated as intravenous morphine equivalent doses for both groups. The impact of pregabalin on postoperative nausea and vomiting (PONV), and length of stay (LOS) was evaluated. Results We included 245 patients in the PG group and 103 in the CTRL group. Median (IQR) opioid consumption over 24 postoperative hours was 15 (8–24) and 17 (8–25) mg in PG and CTRL groups (p = 0.44). We found no difference in postoperative opioid requirement between the two groups in post anesthesia care unit, or within 12 h postoperatively (p = 0.16; p = 0.09). The length of post anesthesia care unit stay was same in each group and there was no difference in PONV Similarly, median postoperative LOS was 31 h in both groups. Conclusion Patients undergoing RALP and receiving multimodal analgesia do not need significant amount of opioids postoperatively and can be discharged soon after the procedure. Pre-emptive administration of oral pregabalin does not reduce postoperative opioid consumption, PONV or LOS in these patients.
Collapse
Affiliation(s)
- K Sisa
- Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland
| | - S Huoponen
- Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland
| | - O Ettala
- Department of Urology, University of Turku, Turku, Finland
| | - H Antila
- Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland.,Department of Anaesthesiology and Intensive Care, University of Turku, Kiinamyllynkatu 4-8, P.O. Box 51, 20521, Turku, Finland
| | - T I Saari
- Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland.,Department of Anaesthesiology and Intensive Care, University of Turku, Kiinamyllynkatu 4-8, P.O. Box 51, 20521, Turku, Finland
| | - P Uusalo
- Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland. .,Department of Anaesthesiology and Intensive Care, University of Turku, Kiinamyllynkatu 4-8, P.O. Box 51, 20521, Turku, Finland.
| |
Collapse
|
13
|
Krimphove MJ, Chen X, Marchese M, Friedlander DF, Fields AC, Roa L, Pucheril D, Kibel AS, Melnitchouk N, Urman RD, Kluth LA, Dasgupta P, Trinh QD. Association of surgical approach and prolonged opioid prescriptions in patients undergoing major pelvic cancer procedures. BMC Surg 2020; 20:235. [PMID: 33054733 PMCID: PMC7557098 DOI: 10.1186/s12893-020-00879-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 09/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The rise in deaths attributed to opioid drugs has become a major public health problem in the United States and in the world. Minimally invasive surgery (MIS) is associated with a faster postoperative recovery and our aim was to investigate if the use of MIS was associated with lower odds of prolonged opioid prescriptions after major procedures. METHODS Retrospective study using the IBM Watson Health Marketscan® Commerical Claims and Encounters Database investigating opioid-naïve cancer patients aged 18-64 who underwent open versus MIS radical prostatectomy (RP), partial colectomy (PC) or hysterectomy (HYS) from 2012 to 2017. Propensity weighted logistic regression analyses were used to estimate the independent effect of surgical approach on prolonged opioid prescriptions, defined as prescriptions within 91-180 days of surgery. RESULTS Overall, 6838 patients underwent RP (MIS 85.5%), 4480 patients underwent PC (MIS 61.6%) and 1620 patients underwent HYS (MIS 41.8%). Approximately 70-80% of all patients had perioperative opioid prescriptions. In the weighted model, patients undergoing MIS were significantly less likely to have prolonged opioid prescriptions in all three surgery types (Odds Ratio [OR] 0.737, 95% Confidence Interval [CI] 0.595-0.914, p = 0.006; OR 0.728, 95% CI 0.600-0.882, p = 0.001; OR 0.655, 95% CI 0.466-0.920, p = 0.015, respectively). CONCLUSION The use of the MIS was associated with lower odds of prolonged opioid prescription in all procedures examined. While additional studies such as clinical trials are needed for further confirmation, our findings need to be considered for patient counseling as postoperative differences between approaches do exist.
Collapse
Affiliation(s)
- Marieke J Krimphove
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 45 Francis St., ASB II-3, Boston, MA, 02115, USA
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Xi Chen
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 45 Francis St., ASB II-3, Boston, MA, 02115, USA
| | - Maya Marchese
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 45 Francis St., ASB II-3, Boston, MA, 02115, USA
| | - David F Friedlander
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 45 Francis St., ASB II-3, Boston, MA, 02115, USA
| | - Adam C Fields
- Division of General and Gastrointestinal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lina Roa
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Daniel Pucheril
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 45 Francis St., ASB II-3, Boston, MA, 02115, USA
| | - Adam S Kibel
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 45 Francis St., ASB II-3, Boston, MA, 02115, USA
| | - Nelya Melnitchouk
- Department of Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Luis A Kluth
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Prokar Dasgupta
- Department of Urology, King's College London, Guy's and St. Thomas' Hospitals NHS Foundation Trust, Guy's Hospital, London, UK
| | - Quoc-Dien Trinh
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 45 Francis St., ASB II-3, Boston, MA, 02115, USA.
| |
Collapse
|
14
|
Chiancone F, Fabiano M, Ferraiuolo M, de Rosa L, Prisco E, Fedelini M, Meccariello C, Visciola G, Fedelini P. Clinical implications of transversus abdominis plane block (TAP-block) for robot assisted laparoscopic radical prostatectomy: A single-institute analysis. Urologia 2020; 88:25-29. [PMID: 32945234 DOI: 10.1177/0391560320957226] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the role of TAP block in improvement of anesthesiological management and perioperative surgical outcomes of robot-assisted laparoscopic radical prostatectomy (RALP). METHODS We consecutive enrolled 93 patients with prostate cancer whose underwent RALP at our department from January 2019 to December 2019. Group A included 45 patients who received bilateral TAP block, and Group B included 48 patients who did not received TAP block. TAP blocks were always performed by a single anesthesia team. An elastomeric pump device was used in all patients for post-operative pain management. TAP block was performed according to Rafi's technique, with Ropivacaine 0.375% and dexamethasone 4 mg. Mean values with standard deviations (±SD) were computed and reported for all items. Statistical significance was achieved if p-value was ⩽0.05 (two-sides). RESULTS The two groups showed no difference in the most important demographics and baseline characteristics (p > 0.05). Group A showed a significant longer time of anaesthesia. Moreover, Ketorolac doses (started dose plus continuous post-operative infusion via elastomeric pump) used in Group A were significantly lower than Group B. Despite this, Group B showed statistical significant higher value of NRS PACU and at 12, 24, 48, 72 h than Group A but not at 96 h. Rescue analgesic medication use was significantly higher in the Group B than Group A. Moreover, patency of the intestinal tract and time to ambulation was significantly lower in the Group A. DISCUSSION The use of TAP block during a RALP is a safe procedure that can be applied more appropriately to achieve better pain control. A multimodal protocol that includes locoregional anesthesia, reduction of intra and postoperative use of strong opiates, correct placing of the patient and the use of low pneumoperitoneum pressures should be implemented in order to reach a faster and better post-operative full recovery of patients whose underwent RALP.
Collapse
Affiliation(s)
| | - Marco Fabiano
- Urology Department, Antonio Cardarelli Hospital, Naples, Italy
| | - Maria Ferraiuolo
- Department of Anesthesiology, TIPO e OTI, Antonio Cardarelli Hospital, Naples, Italy
| | - Lucia de Rosa
- Department of Anesthesiology, TIPO e OTI, Antonio Cardarelli Hospital, Naples, Italy
| | - Elena Prisco
- Department of Anesthesiology, TIPO e OTI, Antonio Cardarelli Hospital, Naples, Italy
| | | | | | - Giulio Visciola
- General and Specialized Surgery for Women and Children, University of Campania Luigi Vanvitelli, Caserta, Campania, Italy
| | - Paolo Fedelini
- Urology Department, Antonio Cardarelli Hospital, Naples, Italy
| |
Collapse
|
15
|
Anaesthetic management for robotic-assisted laparoscopic prostatectomy: the first UK national survey of current practice. J Robot Surg 2020; 15:335-341. [PMID: 32583048 DOI: 10.1007/s11701-020-01105-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/15/2020] [Indexed: 10/24/2022]
Abstract
Robotic-assisted laparoscopic prostatectomy (RALP) is the most common robotic surgical procedure, but there are little published data to inform anaesthetic practice. We aimed to characterise the range of anaesthetic practice for RALP in the United Kingdom through a national survey. We conducted an online national survey to determine current anaesthetic practice for RALP. The survey was distributed to all NHS hospitals within the UK that perform RALP. Thirty-four (79%) of 43 hospitals responded to the survey. Fourteen (41%) centres routinely provide spinal anaesthesia and 79% of these use diamorphine as their intrathecal opioid of choice. Thirty-one (91%) centres administer intravenous strong opioids intraoperatively, and a wide range of non-opioid analgesic agents are also administered. Five (15%) centres reported that they discharge a minority of patients on the day of surgery. High-volume centres are more likely to have a formalised enhanced recovery after surgery (ERAS) pathway and to provide ambulatory surgery for selected patients. This represents the first UK national survey of anaesthetic practice for RALP. The results of the survey revealed significant variation in anaesthetic practice implying a lack of consensus on best perioperative management.
Collapse
|
16
|
Turmel N, Ismael SS, Chesnel C, Charlanes A, Hentzen C, Le Breton F, Amarenco G. Use of a specific questionnaire and perineal electromyography to assess neuropathic pain after radical retropubic prostatectomy. Asian J Urol 2019; 6:364-367. [PMID: 31768323 PMCID: PMC6872839 DOI: 10.1016/j.ajur.2018.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/28/2017] [Accepted: 05/04/2018] [Indexed: 12/20/2022] Open
Abstract
Objective Prostate cancer is the most frequent cancer in men and radical retropubic prostatectomy (RRP) is one of the first-line treatment. However, RRP has some side effects and can lead to chronic perineal pain. The objective of the study was to determine in patients suffering from perineal pain after RRP the possibility of a neurogenic damage by means of a specific questionnaire dedicated to track down neuropathic pain. Methods Forty patients were explored by a specific and validated questionnaire, the Neuropathic Pain Symptom Inventory (NPSI). Patients were divided into two groups: Group A with an NSPI score ≥4 was considered as suffering from neuropathic pain, and Group B was considered as a control group without neuropathic pain (NSPI score <4). All patients had a perineal electrophysiological testing to confirm the possibility of a neurogenic damage. Results Group A was composed by 13 men and Group B by 27 men, with mean age 72.45 years and mean duration of pain 2.7 years. In Group A, the most frequent symptoms were burning sensation, electrical shock and numbness. Location of the pain was global perineal area (8/13), anus (10/13), penis (5/13) and glans penis (2/13). Electromyography (EMG) findings confirmed the presence of denervation and neurogenic damages compared with controls (p < 0.001). Conclusion One third of the patients consulting for chronic pain following RRP had probably a neuropathic lesion leading to a chronic perineal pain as suggested by an NSPI score ≥ 4 and EMG alterations.
Collapse
Affiliation(s)
- Nicolas Turmel
- Department of Neurourology, Tenon Hospital, GRC01 GREEN Group de Recherche Clinical Neurourology, Sorbonne University UPMC, Paris, France
| | - Samer Sheikh Ismael
- Department of Neurourology, Tenon Hospital, GRC01 GREEN Group de Recherche Clinical Neurourology, Sorbonne University UPMC, Paris, France
| | - Camille Chesnel
- Department of Neurourology, Tenon Hospital, GRC01 GREEN Group de Recherche Clinical Neurourology, Sorbonne University UPMC, Paris, France
| | - Audrey Charlanes
- Department of Neurourology, Tenon Hospital, GRC01 GREEN Group de Recherche Clinical Neurourology, Sorbonne University UPMC, Paris, France
| | - Claire Hentzen
- Department of Neurourology, Tenon Hospital, GRC01 GREEN Group de Recherche Clinical Neurourology, Sorbonne University UPMC, Paris, France
| | - Frédérique Le Breton
- Department of Neurourology, Tenon Hospital, GRC01 GREEN Group de Recherche Clinical Neurourology, Sorbonne University UPMC, Paris, France
| | - Gérard Amarenco
- Department of Neurourology, Tenon Hospital, GRC01 GREEN Group de Recherche Clinical Neurourology, Sorbonne University UPMC, Paris, France
| |
Collapse
|
17
|
Bajpai RR, Razdan S, Barack J, Sanchez MA, Razdan S. Ambulatory Robot-Assisted Laparoscopic Prostatectomy: Is It Ready for Prime Time? A Quality of Life Analysis. J Endourol 2019; 33:814-822. [PMID: 31286788 DOI: 10.1089/end.2019.0261] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: To investigate the difference, if any, in the quality of life (QoL) at specified intervals in patients undergoing same day discharge (SDD, ambulatory) vs next day discharge (NDD) after robot-assisted laparoscopic prostatectomy (RALP). Materials and Methods: Two hundred consecutive patients underwent RALP with either SDD or NDD. They completed validated pain and health-related QoL questionnaires at predefined intervals postoperatively and results were compared between the two groups. Results: Pearson's coefficient revealed significant correlations between the time of discharge and physical well-being (r = -0.139; p = 0.005), emotional well-being (EWB) (r = -0.71; p < 0.001), functional assessment of cancer therapy-general (FACT-G) (r = -0.367; p < 0.001), functional assessment of cancer therapy-prostate (FACT-P) (r = -0.273; p < 0.001), pain severity score (PSS) (r = 0.237; p < 0.001), and pain interference score (PIS) (r = 0.214; p < 0.001). Student's t-test revealed significant (p < 0.001) difference in the means of PSS, PIS, EWB, FACT-G, and FACT-P between both groups. Time of discharge was found to be an independent significant predictor (p < 0.01) of PSS and PIS. Pearson's coefficients revealed that PSS had significant correlations with age (r = -0.60; p < 0.001), body mass index (r = 0.87; p < 0.001), and console time (CT) (r = 0.63; p < 0.001). CT also correlated with the estimated blood loss (r = 0.65; p < 0.001). Conclusions: Patients who were discharged the same day as their RALP had lesser pain and interference in general activity scores 2 days after discharge and had better perceived overall health than patients who were discharged on postoperative day 1.
Collapse
Affiliation(s)
| | - Shirin Razdan
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Justin Barack
- Department of Anesthesia, MiVIP Miami Medical Group, Miami, Florida
| | - Marcos A Sanchez
- Division of Clinical and Translational Research, Larkin Community Hospital, South Miami, Florida
| | - Sanjay Razdan
- Department of Urology, International Robotic Prostatectomy Institute, Doral, Florida
| |
Collapse
|
18
|
Application of TAP Block in Laparoscopic Urological Surgery: Current Status and Future Directions. Curr Urol Rep 2019; 20:20. [PMID: 30904960 DOI: 10.1007/s11934-019-0883-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW Amid the opioid crisis, postoperative pain management is a major challenge for practitioners. Recent pain management guidelines emphasize the importance of using regional anesthesia as part of opioid-sparing multimodal analgesia. This report aims to review recent evidence regarding the utilization of transversus abdominis plane (TAP) block in minimally invasive urologic surgery. RECENT FINDINGS TAP block has been shown to improve early and late pain at rest, and to reduce opioid consumption after minimally invasive surgery. These benefits have indirectly reduced the incidence of postoperative delirium, pneumonia, urinary retention, and falls. Compared to epidural analgesia, TAP block provides similar pain control, has a lower incidence of hypotension, and is associated with a shorter length of stay. Few studies focus specifically on the outcomes of TAP block in minimally invasive urologic surgery. TAP block decreases postoperative pain and reduces opioid consumption without increasing complications. TAP block should be integrated as an indispensable component in enhanced recovery after surgery protocols.
Collapse
|
19
|
Shahait M, Yezdani M, Katz B, Lee A, Yu SJ, Lee DI. Robot-Assisted Transversus Abdominis Plane Block: Description of the Technique and Comparative Analysis. J Endourol 2019; 33:207-210. [PMID: 30652509 DOI: 10.1089/end.2018.0828] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Several randomized clinical trials have shown the efficacy of percutaneous transversus abdominis plane (TAP) block in decreasing pain after open and minimally invasive surgeries. We postulated that TAP block could be performed by a robot-assisted transperitoneal approach and provide postoperative pain control equivalent to local anesthetic port infiltration. OBJECTIVE To compare different indicators of postoperative pain between robot-assisted TAP and local anesthetic port infiltration in patients who had undergone robot-assisted radical prostatectomy (RARP). METHODOLOGY A retrospective comparison of 214 consecutive patients undergoing RARP over a 1-year period was conducted. Patient demographics, comorbidities, operative details, and outcomes, including time to ambulation, pain score, narcotic usage, and length of stay, were compared. RESULTS In total, 206 patients were included: 101 received local anesthetic port infiltration and 105 robot-assisted TAP block. There were no differences in estimated blood loss, operative time, time to ambulation, and length of stay between the two groups. The robot-assisted TAP block cohort experienced lesser pain than the local anesthetic port infiltration cohort in the intervals of 6 to 12 hours (2.05 vs 3.21, p = 0.0016) and 12 to 18 hours (2.19 vs 2.97, p = 0.0495) postoperation. CONCLUSION Robot-assisted TAP block is a safe alternative to local anesthetic port-site infiltration. Robot-assisted TAP is associated with lower postoperative pain scores and less narcotic use than local anesthetic port-site infiltration.
Collapse
Affiliation(s)
- Mohammed Shahait
- Division of Urology, University of Pennsylvania Health System, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mona Yezdani
- Division of Urology, University of Pennsylvania Health System, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Benjamin Katz
- Division of Urology, University of Pennsylvania Health System, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexandra Lee
- Division of Urology, University of Pennsylvania Health System, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sue-Jean Yu
- Division of Urology, University of Pennsylvania Health System, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David I Lee
- Division of Urology, University of Pennsylvania Health System, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
20
|
Cacciamani GE, Menestrina N, Pirozzi M, Tafuri A, Corsi P, De Marchi D, Inverardi D, Processali T, Trabacchin N, De Michele M, Sebben M, Cerruto MA, De Marco V, Migliorini F, Porcaro AB, Artibani W. Impact of Combination of Local Anesthetic Wounds Infiltration and Ultrasound Transversus Abdominal Plane Block in Patients Undergoing Robot-Assisted Radical Prostatectomy: Perioperative Results of a Double-Blind Randomized Controlled Trial. J Endourol 2019; 33:295-301. [PMID: 30484332 DOI: 10.1089/end.2018.0761] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determinate benefits of the combination of local anesthetic wounds infiltration and ultrasound transversus abdominal plane (US-TAP) block with ropivacaine on postoperative pain, early recovery, and hospital stay in patients undergoing robot-assisted radical prostatectomy (RARP). METHODS The study is double-blinded randomized controlled trial. Our hypothesis was that the combination of wound infiltration and US-TAP block with ropivacaine would decrease immediate postoperative pain and opioids use. Primary outcomes included postoperative pain and opioids demand during the hospital stay. Secondary outcomes were nausea/vomiting rate, stool passing time, use of prokinetics, length of hospital stay (LOS), and 30-days readmission to the hospital for pain or other US-TAP block-related complications. RESULTS A total of 100 patients who underwent RARP were eligible for the analysis; 57 received the US-TAP block with 20 mL of 0.35% ropivacaine (US-TAP block group) and 43 did not receive US-TAP block (no-US-TAP group). All the patients received the local wound anesthetic infiltration with 20 mL of 0.35% ropivacaine. US-TAP block group showed a decreased mean Numerical Rating Scale (NRS) within 12 hours after surgery (1.6 vs 2.6; p = 0.02) and mean NRS (1.8 vs 2.7; p = 0.04) with lesser number of patients who used opioid (3.5% vs 18.6%; p = 0.01) during the first 24 hours. Moreover, we found a shorter mean LOS (4.27 vs 4.72, days; p = 0.04) with a lower requirement of prokinetics administration during the hospital stay (21% vs 72%; p < 0.001). No US-TAP block-related complications were reported. CONCLUSION Combination of anesthetic wound infiltration and US-TAP block with ropivacaine as part of a multimodal analgesic regimen can be safely offered to patients undergoing RARP and extended pelvic lymph node dissection. It improves the immediate postoperative pain control, reducing opioids administration and is associated to a decreased use of prokinetics and shorter hospital stay.
Collapse
Affiliation(s)
| | - Nicola Menestrina
- 2 Department of Anesthesiologist and Intensive Care University of Verona, Italy.,3 Department of Anesthesiologist and Intensive Care Ospedale Sacro Cuore Don Calabia, Negrar, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Lee B, Schug SA, Joshi GP, Kehlet H, Bonnet F, Lavand’Homme P, Lirk P, Pogatzki-Zahn E, Raeder J, Rawal N, van der Velde M. Procedure-Specific Pain Management (PROSPECT) - An update. Best Pract Res Clin Anaesthesiol 2018; 32:101-111. [PMID: 30322452 DOI: 10.1016/j.bpa.2018.06.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 06/18/2018] [Indexed: 11/26/2022]
Abstract
Post-operative pain management protocols may be optimised by examining procedure-specific evidence and outcomes. This recognition led to the formation of the PROcedure-SPECific Pain ManagemenT (PROSPECT) collaboration of anaesthesiologists and surgeons. The aim of PROSPECT is to provide practical and evidence-based recommendations to prevent and treat post-operative pain after specific surgical procedures, thereby overcoming the limitations of generic, non-specific guidelines. Updates in the methodology of PROSPECT in 2017 have placed an increased emphasis on the clinical relevance of studies, including a focus on interventions in the context of multimodal analgesia strategies and consideration of risks and benefits of interventions in specific surgical settings. Evidence-based reviews of analgesic measures, including advice on surgical techniques and adjuvants after diverse surgical procedures, have been completed by the PROSPECT collaboration and are accessible on the website (www.postoppain.org) and published in the peer-reviewed literature. These reviews continue to identify significant gaps in clinically relevant research on post-operative analgesia and are possibly leading to a closing of some of these gaps.
Collapse
Affiliation(s)
- Brian Lee
- Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Australia
| | - Stephan A Schug
- Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Australia; Anaesthesiology and Pain Medicine, Medical School, University of Western Australia, Perth, Australia.
| | - Girish P Joshi
- University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Henrik Kehlet
- Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Hwang BY, Kwon JY, Jeon SE, Kim ES, Kim HJ, Lee HJ, An J. Comparison of patient-controlled epidural analgesia with patient-controlled intravenous analgesia for laparoscopic radical prostatectomy. Korean J Pain 2018; 31:191-198. [PMID: 30013733 PMCID: PMC6037808 DOI: 10.3344/kjp.2018.31.3.191] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/20/2018] [Accepted: 06/20/2018] [Indexed: 12/19/2022] Open
Abstract
Background Patient-controlled epidural analgesia (PCEA) is known to provide good postoperative analgesia in many types of surgery including laparoscopic surgery. However, no study has compared PCEA with patient-controlled intravascular analgesia (PCIA) in laparoscopic radical prostatectomy (LARP). In this study, the efficacy and side effects of PCEA and PCIA after LARP were compared. Methods Forty patients undergoing LARP were randomly divided into two groups: 1) a PCEA group, treated with 0.2% ropivacaine 3 ml and 0.1 mg morphine in the bolus; and 2) a PCIA group, treated with oxycodone 1 mg and nefopam 1 mg in the bolus. After the operation, a blinded observer assessed estimated blood loss (EBL), added a dose of rocuronium, performed transfusion, and added analgesics. The numeric rating scale (NRS), infused PCA dose, and side effects were assessed at 1, 6, 24, and 48 h. Results EBL, added rocuronium, and added analgesics in the PCEA group were less than those in the PCIA group. There were no significant differences in side-effects after the operation between the two groups. Patients were more satisfied with PCEA than with PCIA. The NRS and accumulated PCA count were lower in PCEA group. Conclusions Combined thoracic epidural anesthesia could induce less blood loss during operations. PCEA showed better postoperative analgesia and greater patient satisfaction than PCIA. Thus, PCEA may be a more useful analgesic method than PICA after LARP.
Collapse
Affiliation(s)
- Boo Young Hwang
- Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jae Young Kwon
- Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - So Eun Jeon
- Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Eun Soo Kim
- Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hyae Jin Kim
- Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hyeon Jeong Lee
- Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jihye An
- Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| |
Collapse
|
23
|
Corcione A, Angelini P, Bencini L, Bertellini E, Borghi F, Buccelli C, Coletta G, Esposito C, Graziano V, Guarracino F, Marchi D, Misitano P, Mori AM, Paternoster M, Pennestrì V, Perrone V, Pugliese L, Romagnoli S, Scudeller L, Corcione F. Joint consensus on abdominal robotic surgery and anesthesia from a task force of the SIAARTI and SIC. Minerva Anestesiol 2018; 84:1189-1208. [PMID: 29648413 DOI: 10.23736/s0375-9393.18.12241-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Minimally invasive surgical procedures have revolutionized the world of surgery in the past decades. While laparoscopy, the first minimally invasive surgical technique to be developed, is widely used and has been addressed by several guidelines and recommendations, the implementation of robotic-assisted surgery is still hindered by the lack of consensus documents that support healthcare professionals in the management of this novel surgical procedure. Here we summarize the available evidence and provide expert opinion aimed at improving the implementation and resolution of issues derived from robotic abdominal surgery procedures. A joint task force of Italian surgeons, anesthesiologists and clinical epidemiologists reviewed the available evidence on robotic abdominal surgery. Recommendations were graded according to the strength of evidence. Statements and recommendations are provided for general issues regarding robotic abdominal surgery, operating theatre organization, preoperative patient assessment and preparation, intraoperative management, and postoperative procedures and discharge. The consensus document provides evidence-based recommendations and expert statements aimed at improving the implementation and management of robotic abdominal surgery.
Collapse
Affiliation(s)
- Antonio Corcione
- Department of Critical Care Area, A.O. Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Pierluigi Angelini
- Department of General, Laparoscopic and Robotic Surgery, A.O. Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Lapo Bencini
- Division of Surgical Oncology and Robotics, Department of Oncology, Careggi University Hospital, Florence, Italy
| | - Elisabetta Bertellini
- Department of Anesthesia and Intensive Care, New Civile S. Agostino-Estense, Policlinico Hospital, Modena, Italy
| | - Felice Borghi
- Division of General and Surgical Oncology, Department of Surgery, S. Croce e Carle Hospital, Cuneo, Italy
| | - Claudio Buccelli
- Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Giuseppe Coletta
- Division of Operating Room Management, Department of Emergency and Critical Care, S. Croce e Carle Hospital, Cuneo, Italy
| | - Clelia Esposito
- Department of Critical Care Area, A.O. Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Vincenzo Graziano
- Department of Anesthesia and Critical Care Medicine, Cardiothoracic Anesthesia and Intensive Care, Pisa University Hospital, Pisa, Italy
| | - Fabio Guarracino
- Department of Anesthesia and Critical Care Medicine, Cardiothoracic Anesthesia and Intensive Care, Pisa University Hospital, Pisa, Italy
| | - Domenico Marchi
- Department of General Surgery, New Civile S. Agostino-Estense, Policlinico Hospital, Modena, Italy
| | - Pasquale Misitano
- Unit of General and Mini-Invasive Surgery, Department of General Surgery, Misericordia Hospital, Grosseto, Italy
| | - Anna M Mori
- Department of Anesthesiology and Reanimation, IRCCS Policlinic San Matteo Foundation, Pavia, Italy
| | - Mariano Paternoster
- Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Vincenzo Pennestrì
- Department of Anesthesia and Intensive Care Medicine, Misericordia Hospital, Grosseto, Italy
| | - Vittorio Perrone
- Department of General and Transplant Surgery, Pisa University Hospital, Pisa, Italy
| | - Luigi Pugliese
- Unit of General Surgery 2, IRCCS Policlinic San Matteo, Foundation, Pavia, Italy
| | - Stefano Romagnoli
- Department of Anesthesia and Critical Care, Careggi University Hospital, Florence, Italy
| | - Luigia Scudeller
- Unit of Clinical Epidemiology, Scientific Direction, IRCCS Policlinic San Matteo Foundation, Pavia, Italy -
| | - Francesco Corcione
- Department of General, Laparoscopic and Robotic Surgery, A.O. Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | | |
Collapse
|
24
|
Maquoi I, Joris JL, Dresse C, Vandenbosch S, Venneman I, Brichant JF, Hans GA. Transversus abdominis plane block or intravenous lignocaine in open prostate surgery: a randomized controlled trial. Acta Anaesthesiol Scand 2016; 60:1453-1460. [PMID: 27507582 DOI: 10.1111/aas.12773] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 07/06/2016] [Accepted: 07/12/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Transversus abdominis plane block (TAP) and intravenous lignocaine are two analgesic techniques frequently used after abdominal surgery. We hypothesized that these two techniques improve post-operative analgesia after open prostate surgery and sought to compare their efficacy on immediate post-operative outcome after open prostate surgery. METHODS After ethics committee approval, 101 patients were enrolled in this prospective study and randomly allocated to receive bilateral ultrasound-guided TAP (n = 34), intravenous lignocaine (n = 33) or placebo (n = 34). In addition, intravenous paracetamol was given every 6 h. The primary endpoint was the cumulative opioid consumption during the first 48 post-operative hours (median[IQR]). Secondary endpoints included pain scores at rest and upon coughing, need for rescue tramadol, incidence of post-operative nausea and vomiting (PONV), recovery of bowel function and incidence of bladder catheter-related discomfort. RESULTS Cumulative piritramide consumption after 48 h was 28 [23] mg in the control group, 21 [29] mg in the TAP group and 21 [31] mg in the lignocaine group (P = 0.065). There was no significant difference in post-operative pain scores between groups. The proportions of patients requiring rescue tramadol, experiencing PONV or bladder catheter-related discomfort were similar in each group. Recovery of bowel function was also similar in the three groups. CONCLUSIONS Our study suggests that TAP block and intravenous lignocaine do not improve the post-operative analgesia provided by systematic administration of paracetamol after open prostatectomy.
Collapse
Affiliation(s)
- I. Maquoi
- Department of Anaesthesia and Intensive Care Medicine; CHU of Liege; University of Liege; Liege Belgium
| | - J. L. Joris
- Department of Anaesthesia and Intensive Care Medicine; CHU of Liege; University of Liege; Liege Belgium
| | - C. Dresse
- Department of Anaesthesia and Intensive Care Medicine; CHR de la Citadelle; Liege Belgium
| | - S. Vandenbosch
- Department of Anaesthesia and Intensive Care Medicine; CHU of Liege; University of Liege; Liege Belgium
| | - I. Venneman
- Department of Anaesthesia and Intensive Care Medicine; CHU of Liege; University of Liege; Liege Belgium
| | - J.-F. Brichant
- Department of Anaesthesia and Intensive Care Medicine; CHU of Liege; University of Liege; Liege Belgium
| | - G. A. Hans
- Department of Anaesthesia and Intensive Care Medicine; CHU of Liege; University of Liege; Liege Belgium
| |
Collapse
|