Optimal pain management for radical prostatectomy surgery: what is the evidence?

Abstract

BackgroundIncrease in the diagnosis of prostate cancer has increased the incidence of radical prostatectomy. However, the literature assessing pain therapy for this procedure has not been systematically evaluated. Thus, optimal pain therapy for patients undergoing radical prostatectomy remains controversial.MethodsMedline, Embase, and Cochrane Central Register of Controlled Trials were searched for studies assessing the effects of analgesic and anesthetic interventions on pain after radical prostatectomy. All searches were conducted in October 2012 and updated in June 2015.ResultsMost treatments studied improved pain relief and/or reduced opioid requirements. However, there were significant differences in the study designs and the variables evaluated, precluding quantitative analysis and consensus recommendations.ConclusionsThis systematic review reveals that there is a lack of evidence to develop an optimal pain management protocol in patients undergoing radical prostatectomy. Most studies assessed unimodal analgesic approaches rather than a multimodal technique. There is a need for more procedure-specific studies comparing pain and analgesic requirements for open and minimally invasive surgical procedures. Finally, while we wait for appropriate procedure specific evidence from publication of adequate studies assessing optimal pain management after radical prostatectomy, we propose a basic analgesic guideline.

Transversus abdominis plane block or intravenous lignocaine in open prostate surgery: a randomized controlled trial

“…The authors of this meta-analysis also established that the cumulative opioid-sparing effect of the TAP block was 11 mg after 24 h, which they qualified marginal and of questionable clinical relevance. 13 There is no gold standard technique that could have been used as a positive control in this setting. Another recent randomized controlled trial showed that dual transversus abdominis plane block reduced pain scores upon sitting after laparoscopic appendectomy.…”

“…This lack of effect is in agreement with the little evidence supporting the efficacy of TAP block or intravenous lignocaine for open prostatectomy despite their widespread use. 13 There is no gold standard technique that could have been used as a positive control in this setting. In particular, epidural analgesia was considered but rejected because the risk-benefit ratio was deemed unfavourable.…”

“…13 We hypothesized that TAP block and intravenous lignocaine improve post-operative analgesia after open prostatectomy and sought to determine whether one of the two techniques was superior to the other. The authors of a recent review on pain management after prostatectomy claimed that more randomized controlled trials were necessary to assess the efficacy of intravenous lignocaine and to evaluate the risk-benefit ratio of TAP blocks.…”

“…The authors of a recent review on pain management after prostatectomy claimed that more randomized controlled trials were necessary to assess the efficacy of intravenous lignocaine and to evaluate the risk-benefit ratio of TAP blocks. 13 We hypothesized that TAP block and intravenous lignocaine improve post-operative analgesia after open prostatectomy and sought to determine whether one of the two techniques was superior to the other. We also investigated the effects of these analgesic techniques on the recovery of bowel function, pain scores, postoperative nausea and vomiting, and need for rescue analgesics were compared between the groups.…”

Analgesia Epidural Postoperatoria: ¿cuál es su papel en la práctica anestésica actual?

“…En cirugía urológica y ginecológica abierta, con incisiones infraumbilicales o lumbotomías, con estancias hospitalarias cortas y bajas demandas analgésicas, tampoco se recomienda la analgesia epidural, que produciría más riesgos que beneficios (12,13). En la nefrectomía y el implante renal, el bloqueo TAP proporciona una buena analgesia postoperatoria, disminuyendo el consumo de opioides (14).…”