PROSPECT guidelines update for evidence-based pain management after prostatectomy for cancer

Lemoine, Adrien; Witdouck, Annemijn; Beloeil, Hélène; Bonnet, Francis

doi:10.1016/j.accpm.2021.100922

Cited by 18 publications

(9 citation statements)

References 61 publications

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“…Truncal blocks as an addition to local wound infiltration have been used with promising outcomes and have proved to be superior to wound infiltration alone (Cacciamani et al, 2019[ 5 ]; Taha et al, 2019[ 22 ]). Transversus abdominis plane (TAP) block is currently recommended for laparoscopic and robotic prostatectomy by the recent procedure specific postoperative pain management (PROSPECT) guidelines (Lemoine et al, 2021[ 17 ]).…”

Section: Introductionmentioning

confidence: 99%

Ultrasound–guided posterior quadratus lumborum block for postoperative pain control after minimally invasive radical prostatectomy: a randomized, double–blind, placebo–controlled trial

Horosz

Bialowolska

Kociuba

et al. 2022

EXCLI Journal; 21:Doc335; ISSN 1611-2156

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A minimally invasive approach to radical prostatectomy offers improved ambulation and discharge times. Postoperative pain control is one of the key factors that facilitates rapid recovery. With the aim to assure adequate analgesia and minimize the use of opioids, application of truncal nerve blocks has been proposed in a number of endoscopic procedures. The aim of this double-blind, placebo-controlled study was to evaluate the efficacy of bilateral posterior quadratus lumborum block (pQLB) in alleviating pain and reducing postoperative opioid demand in patients following endoscopic extraperitoneal and laparoscopic prostatectomy. We enrolled 50 patients who were diagnosed with prostate cancer and scheduled for prostatectomy. They were randomized to receive preoperative, ultrasound-guided pQLB with the use of either 30 ml of 0.375 % ropivacaine (ropivacaine group) or 30 ml of 0.9 % NaCl (placebo group). Our primary endpoint was opioid consumption in the first 24 hours after surgery. Secondary endpoints were pain intensity at predefined timepoints and the incidence of nausea and vomiting and pruritus. No differences were detected between the ropivacaine and placebo groups in intravenous oxycodone consumption during the first 24 hours after surgery. Similarly, there were no differences in pain intensity at any of the timepoints assessed. The rate of nausea and vomiting was equal in both groups and pruritus was not observed. Application of bilateral pQLB does not reduce opioid consumption after minimally invasive prostatectomy.

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Section: Introductionmentioning

confidence: 99%

Ultrasound–guided posterior quadratus lumborum block for postoperative pain control after minimally invasive radical prostatectomy: a randomized, double–blind, placebo–controlled trial

Horosz

Bialowolska

Kociuba

et al. 2022

EXCLI Journal; 21:Doc335; ISSN 1611-2156

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“…[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. [7,15] Fascial plane blocks are regional anesthetic techniques that target the space between 2 layers of fascia rather than a specific nerve or plexus.…”

Section: Discussionmentioning

confidence: 99%

“…[6] Optimal pain management is well known to affect postoperative recovery and a multimodal approach to pain management should be adopted in minimally invasive surgeries. [7] Regional anesthesia and analgesic techniques are used in addition to medical treatment in the multimodal approach in postoperative pain management. Fascial plane blocks are becoming increasingly important, especially in minimally invasive surgeries.…”

Section: Introductionmentioning

confidence: 99%

“…Fascial plane blocks are becoming increasingly important, especially in minimally invasive surgeries. [7][8][9] Another important cause of discomfort is the urinary catheter pain. Although various studies have investigated catheter-related bladder discomfort (CRBD), no consensus has been achieved concerning the mechanisms involved and its prevention.…”

Section: Introductionmentioning

confidence: 99%

“…[6] Optimal pain management is well known to affect postoperative recovery and a multimodal approach to pain management should be adopted in minimally invasive surgeries. [7]…”

Section: Introductionmentioning

confidence: 99%

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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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Anesthesia in Robotic Surgery

Chiumello,

Duscio

2024

Practical Trends in Anesthesia and Intensive Care 2022

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PROSPECT guidelines update for evidence-based pain management after prostatectomy for cancer

Cited by 18 publications

References 61 publications

Ultrasound–guided posterior quadratus lumborum block for postoperative pain control after minimally invasive radical prostatectomy: a randomized, double–blind, placebo–controlled trial

Ultrasound–guided posterior quadratus lumborum block for postoperative pain control after minimally invasive radical prostatectomy: a randomized, double–blind, placebo–controlled trial

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

Anesthesia in Robotic Surgery

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