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Chedgy ECP, Tang R, Struss WJ, Lowe G, Sawka A, Vaghadia H, Froehlich K, Black PC, Gleave ME, So AI. A randomized controlled trial investigating rectus sheath catheters following radical cystectomy. BJU Int 2023; 132:554-559. [PMID: 37259473 DOI: 10.1111/bju.16094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To evaluate whether rectus sheath catheter (RSC) insertion may be an alternative to thoracic epidural (TE). PATIENTS AND METHODS In a non-blinded, single-centre, non-inferiority study, patients undergoing open radical cystectomy were randomized 1:1 to receive either a TE or surgically placed RSC. The primary endpoint was cumulative opiate use (median oral morphine equivalent [OME]) in the first 72 h postoperatively. Secondary outcomes included visual analogue scale pain scores, measures of postoperative recovery including mobility and time to regular diet, and complications. RESULTS Ninety-seven patients were randomized (51 TE, 46 RSC). The median OME was 103 (77.5-132.5) mg in the TE arm and 161.75 (117.5-187.5) mg in the RSC arm. A Mann-Whitney U-test confirmed non-inferiority of RSC to TE at a threshold of 15 mg OME (P = 0.002). When comparing pain scores for the first three postoperative days, an early difference was observed that favoured the TE group during post-anaesthesia care unit stay, which was lost after postoperative day 1. Patient satisfaction with analgesia on the third postoperative day was similar in the two arms (P = 0.47). There were no statistically significant differences between arms with respect to the other secondary outcomes. CONCLUSIONS The outcomes from this prospective randomized trial demonstrated non-inferiority of RSC insertion compared to TE with respect to 72-h opiate use. Patient satisfaction with pain control on postoperative day 3 was the same for each group.
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Affiliation(s)
- Edmund C P Chedgy
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
- Department of Urology, University Hospital Southampton, Hampshire, UK
| | - Raymond Tang
- Department of Anesthesia, University of British Columbia, Vancouver, BC, Canada
| | - Werner J Struss
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
- Department of Urology, University Hospital Southampton, Hampshire, UK
| | - Genevieve Lowe
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Andrew Sawka
- Department of Anesthesia, University of British Columbia, Vancouver, BC, Canada
| | - Himat Vaghadia
- Department of Anesthesia, University of British Columbia, Vancouver, BC, Canada
| | - Kevin Froehlich
- Department of Anesthesia, University of British Columbia, Vancouver, BC, Canada
| | - Peter C Black
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Martin E Gleave
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Alan I So
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
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Mantica G, Leonardi R, Pini G, Esperto F, Proietti S, van Deventer H, Giusti G, Gaboardi F, van der Merwe A, Terrone C. The current use of human cadaveric models in urology: a systematic review. MINERVA UROL NEFROL 2020; 72:313-320. [DOI: 10.23736/s0393-2249.19.03558-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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