Evaluation of analgesic requirements and postoperative recovery after radical retropubic prostatectomy using long-acting spinal anesthesia

Sved, Paul; Nieder, Alan M.; Manoharan, Murugesan; Gómez, Pablo; Meinbach, David S.; Kim, Sandy S.; Soloway, Mark S.

doi:10.1016/j.urology.2004.09.063

Cited by 17 publications

(10 citation statements)

References 13 publications

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“…In an effort to further minimize the morbidity of RRP, variations continue to be developed. For example, an approach using a modified Pfannenstiel incision with spinal anesthesia was recently described, resulting in improved cosmesis and lower postoperative analgesic requirements [15].…”

Section: Techniquementioning

confidence: 99%

Laparoscopic and robotic radical prostatectomy

Gettman

2006

Expert Review of Anticancer Therapy

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Radical retropubic prostatectomy is the current gold standard for surgical removal of the prostate gland. Recently, laparoscopic radical prostatectomy has been developed in an attempt to decrease surgical morbidity, and the technical difficulty of laparoscopy has been countered with the development of the da Vinci robotic interface. Studies that have compared the minimally invasive approaches with the traditional open approach have reported comparable perioperative outcomes. While long-term oncological data are available for open prostatectomy, there are only short-term studies available for laparoscopic prostatectomy. Functional outcomes, including urinary continence and sexual function, appear to be similar between the surgical approaches in the short term. However, currently, costs appear to favor open surgery, with the da Vinci-assisted prostatectomy having the highest expenses. Longer-term data are required to confidently determine the optimal balance between morbidity, oncological efficacy, functional outcomes and cost among the differing surgical approaches.

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Section: Techniquementioning

confidence: 99%

Laparoscopic and robotic radical prostatectomy

Gettman

2006

Expert Review of Anticancer Therapy

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“…A standard laparoscopic camera and lens were used for visualization and to aid surgical assistants. Alternatively, Sved et al [4] reported RRP performed through a modified Pfannenstiel incision under spinal anesthesia. Using this approach, patients had improved cosmesis, little postoperative pain, low analgesic requirements, and a mean convalescence of 19 days.…”

Section: Techniquementioning

confidence: 99%

“…The advent of minimally invasive surgery has influenced change in open surgery. Those performing open surgeries have reduced incision lengths, incorporated loupe magnification, increased loupe magnification power (Myers, personal communication), and have changed postoperative clinical pathways to streamline the RRP perioperative course [3,4,19]. Laparoscopic surgeons also have modified surgical techniques to mirror that of RRP in an attempt to maximize continence and sexual function results [20][21][22][23].…”

Section: Introductionmentioning

confidence: 99%

Critical comparison of laparoscopic, robotic, and open radical prostatectomy: Techniques, outcomes, and cost

Gettman¹,

Blute

2007

Current prostate reports

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Radical prostatectomy has maintained paramount importance in prostate cancer management. Emerging alternative treatments are laparoscopic and robotic prostatectomy. Technical modifications have improved radical prostatectomy outcomes, yet surgery remains difficult to perform regardless of approach. Contemporary series have shown comparable outcomes with operative time, transfusion rates, analgesia, and length of catheterization. Open radical prostatectomy provides excellent long-term oncologic control, but sparse shortterm data are available for laparoscopic and robotic prostatectomy. Favorable outcomes also have been reported for urinary control and sexual function, regardless of approach. Additional prospective data collection is needed to evaluate if minimally invasive approaches provide distinct advantages over open surgery.

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“…5 We have previously reported that the postoperative pain and analgesic requirement are minimal when this approach is combined with long-acting spinal anesthesia. 21 Soulie et al 14 and Kiyokawa et al 22 reported that the horizontal approach was associated with reduced analgesic consumption when compared with a vertical midline incision. Incisional hernia is rare with a Pfannenstiel incision (0-2%).…”

Section: Modified Pfannenstiel Approach M Manoharan Et Almentioning

confidence: 99%

Modified Pfannenstiel approach for radical retropubic prostatectomy: a 3-year experience

Manoharan

Ayyathurai

Nieder

et al. 2007

Prostate Cancer Prostatic Dis

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A modified Pfannenstiel approach for radical retropubic prostatectomy (RRP) has been described previously. We present our experience with this approach for performing a RRP over the past 3 years. Between January 2003 and July 2006, 544 consecutive RRPs by modified Pfannenstiel approach between January 2003 and July 2006 were performed. We analyzed blood loss, transfusions, use of drain, pain score, analgesia and hospital stay. Patients were followed up at 6 weeks, three monthly for a year and six monthly thereafter. All clinical and operative variables were entered into a database and analyzed. A total of 544 men underwent RRP with median follow-up of 11 (s.d.710.5) months. The mean age was 60 (s.d.77) years. About 83, 91 and 95% of patients had nerve sparing, bladder neck preservation and a lymph node dissection, respectively. Fifty-three patients had a concurrent inguinal hernia repair through the same incision. Mean estimated blood loss was 431(s.d.7267) ml. The pathological staging distribution was T2, 82%; T3a, 9%; and T3b, 9%. The mean pain score at days 1 and 7 were 3.7 (s.d.72.5) and 3.3 (s.d.73), respectively. The median hospital stay was 36 h (s.d.724). About 5.5% have had biochemical recurrence. At 12 months 97% were continent and 46% potent. RRP using a modified Pfannenstiel approach offers safety and efficacy. It facilitates repair of associated inguinal hernia through the same incision.

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Evaluation of analgesic requirements and postoperative recovery after radical retropubic prostatectomy using long-acting spinal anesthesia

Cited by 17 publications

References 13 publications

Laparoscopic and robotic radical prostatectomy

Laparoscopic and robotic radical prostatectomy

Critical comparison of laparoscopic, robotic, and open radical prostatectomy: Techniques, outcomes, and cost

Modified Pfannenstiel approach for radical retropubic prostatectomy: a 3-year experience

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