Implementation of a multimodal opioid-sparing enhanced recovery pathway for robotic-assisted radical prostatectomy

Ashrafi, Akbar; Yip, Wesley; Graham, J.; Yu, Valerie; Titus, Micha; Widjaja, W.; Dickerson, Shane; Berger, André; Desai, Mihir; Gill, Inderbir S.; Aron, Monish; Kim, Michael P.

doi:10.1007/s11701-021-01268-7

Cited by 6 publications

(7 citation statements)

References 32 publications

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“…On discharge, patients receive a pro re nata 10-day supply of acetaminophen, ibuprofen, and methocarbamol. Our approach is similar to that of recently published studies reporting on the excellent analgesic effect of opioid-sparing protocols following RARP with the exception that we do not use pre-operative rehabilitation pathways ( 56 , 57 ). The caveat is that post-surgical pain-control in patients after a radical prostatectomy tends to be favorable regardless of approach.…”

Section: Discussionmentioning

confidence: 85%

Robot-assisted radical prostatectomy: Advancements in surgical technique and perioperative care

et al. 2022

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Section: Discussionmentioning

confidence: 85%

Robot-assisted radical prostatectomy: Advancements in surgical technique and perioperative care

et al. 2022

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“…If postoperative pain is not effectively treated, some of the most important benefits of minimally invasive surgery may not be achieved, and side-effects may occur due to the use of opioid analgesics. [11][12][13][14] Various analgesic methods are used for RARP, the main steps consisting of regional analgesia techniques and opioid and nonopioid analgesics. [13,14] As in all robotic and laparoscopic surgeries, multimodal analgesia methods are recommended.…”

Section: Discussionmentioning

confidence: 99%

“…[11][12][13][14] Various analgesic methods are used for RARP, the main steps consisting of regional analgesia techniques and opioid and nonopioid analgesics. [13,14] As in all robotic and laparoscopic surgeries, multimodal analgesia methods are recommended. [12,15] The PROSPECT guideline recommends reducing and limiting opioid consumption in prostatectomy operations [7,15] describing the use of non-opioid agents such as paracetamol and fascial plane blocks, especially the transversus abdominis plane block (TAP) block, as effective and recommended.…”

Section: Discussionmentioning

confidence: 99%

The effect of ultrasound-guided rectus sheath block on postoperative analgesia in robot assisted prostatectomy: A randomized controlled trial

Coşarcan,

Gürkan,

Manici

et al. 2024

Medicine

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Background: Postoperative pain continues to represent an important problem even after minimally invasive robotic-assisted laparoscopic radical prostatectomy, which results in discomfort in the postoperative period and sometimes prolongs hospital stays. Regional anesthesia and analgesia techniques are used in addition to systemic analgesics with the multimodal approach in postoperative pain management. Ultrasound-guided fascial plane blocks are becoming increasingly important, especially in minimally invasive surgeries. Another important cause of discomfort is urinary catheter pain. The present randomized controlled study investigated the effect of rectus sheath block on postoperative pain and catheter-related bladder discomfort in robotic prostatectomy operations. Methods: This randomized controlled trial was conducted from March to August 2022. Written informed consent was obtained from all participants. Approval for the study was granted by the Clinical Research Ethics Committee. All individuals provided written informed consent, and adults with American Society of Anesthesiologists Physical Condition classification I to III planned for robotic prostatectomy operations under general anesthesia were enrolled. Following computer-assisted randomization, patients were divided into 2 groups, and general anesthesia was induced in all cases. Rectus sheath block was performed under general anesthesia and at the end of the surgery. No fascial plane block was applied to the patients in the non-rectus sheath block (RSB) group. Postoperative pain and urinary catheter pain were assessed using a numerical rating scale. Fentanyl was planned as rescue analgesia in the recovery room. In case of numerical rating scale scores of 4 or more, patients were given 50 µg fentanyl IV, repeated if necessary. The total fentanyl dose administered was recorded in the recovery room. IV morphine patient-controlled analgesia was planned for all patients. All patients’ pain (postoperative pain at surgical site and urethral catheter discomfort) scores and total morphine consumption in the recovery unit and during follow-ups on the ward (3, 6, 12, and 24 hours) in the postoperative period were recorded. Results: Sixty-one patients were evaluated. Total tramadol consumption during follow-up on the ward was significantly higher in the non-RSB group. Fentanyl consumption in the postanesthesia care unit was significantly higher in the non-RSB group. Total morphine consumption was significantly lower in the RSB group at 0 to 12 hours and 12 to 24 hours. Total opioid consumption was 8.81 mg in the RSB group and 19.87 mg in the non-RSB group. A statistically significant decrease in urethral catheter pain was noted in the RSB group at all time points. Conclusion: RSB exhibits effective analgesia by significantly reducing postoperative opioid consumption in robotic prostatectomy operations.

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“…Oral opioids are avoided where possible due to their side effects, particularly nausea, drowsiness and detrimental effects on gut motility. Similar single‐centre ERAS programmes have also used opiate‐sparing regimes to improve pain control and reduce length of stay [12]. Irritation from the urinary catheter is often the main site of discomfort following RALP and, in our experience, systemic analgesia does not ease this, whereas early mobilization abrogates this symptom.…”

Section: Discussionmentioning

confidence: 99%

Same‐day discharge robot‐assisted laparoscopic prostatectomy: feasibility, safety and patient experience

et al. 2023

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To report a single centre's experience of the feasibility, safety and patient acceptability of same-day discharge robot-assisted laparoscopic prostatectomy (RALP). Subjects/Patients and MethodsBetween June 2015 and December 2021, a total of 180 pre-selected consecutive patients underwent RALP with the intention to discharge on the same day as surgery. Cases were performed by two surgeons. An enhanced recovery after surgery (ERAS) programme was used. The feasibility of same-day discharge was analysed, along with the complication rate, oncological outcomes, and postoperative patient experience. ResultsOf 180 patients, 169 (93.8%) were successfully discharged on the same day as surgery. The median (range) age was 63 ( 44-74) years. The median (range) console time was 97 (61-256) min and blood loss was 200 (20-800) mL. The resection specimen pathology results were: pT2 69.4%, pT3a 24.4% and pT3b 6.5%. With regard to Gleason Grade Group (GGG), 25.9% had GGG 1, 65.7% had GGG 2-3 and 8.4% had GGG 4-5 disease. Positive surgical margins were present in 25 cases (14.7%), 18 (15.5%) of which occurred in pT2 cases, and seven (13.4%) in pT3 cases. There were no early (<90 days) biochemical relapses (defined as prostate-specific antigen level >0.2 ng/mL). The 30-day readmission rate was 3%. A total of 13 early (0-30 days) complications were observed, five of which were Clavien-Dindo grade ≥3, however, none of these would have been avoided had the patient remained in hospital on the first postoperative night. Of 121 consecutive patients, 107 (88%) returned a satisfaction questionnaire, and 92% of responders stated they preferred recovery at home, with 94% stating they felt ready to go home. ConclusionRobot-assisted laparoscopic prostatectomy combined with an ERAS programme allows patients to be safely discharged home on the same day of their surgery. This is a feasible option, well-liked by patients, with morbidity and oncological outcomes similar to non-day-case or 23 h stay RALP.

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Implementation of a multimodal opioid-sparing enhanced recovery pathway for robotic-assisted radical prostatectomy

Cited by 6 publications

References 32 publications

Robot-assisted radical prostatectomy: Advancements in surgical technique and perioperative care

Robot-assisted radical prostatectomy: Advancements in surgical technique and perioperative care

The effect of ultrasound-guided rectus sheath block on postoperative analgesia in robot assisted prostatectomy: A randomized controlled trial

Same‐day discharge robot‐assisted laparoscopic prostatectomy: feasibility, safety and patient experience

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