Robot-Assisted Radical Prostatectomy Associated with Decreased Persistent Postoperative Opioid Use

Abstract

Introduction: Minimally invasive surgery offers reduced pain and opioid use postoperatively compared with open surgery, but large-scale comparative studies are lacking. We assessed the incidence of persistent opioid use after open and robot-assisted radical prostatectomy (RARP). Materials and Methods:We performed a retrospective claims database cohort study of opioid-naive (i.e., no opioid prescriptions 30-180 days before index surgery) adult males who underwent radical prostatectomy for prostate cancer from July 2013 to June 2017. For patients who filled a perioperative opioid prescription (30 days before to 14 days after surgery), we calculated the incidence of new persistent postoperative opioid use ( ‡1 prescription 90-180 days after surgery). Multivariable logistic regression was performed to investigate the association between the surgical approach, patient risk factors, and persistent opioid use. Results: Twelve thousand two hundred seventy-eight radical prostatectomy patients filled an opioid prescription perioperatively (1510 [12%] open and 10,768 [88%] robot assisted). Of these, 846 (6.9%) patients continued to fill opioid prescription(s) 90 to 180 days after surgery. Patients undergoing RARP were 35% less likely to develop new persistent opioid use compared with those undergoing open radical prostatectomy (6.5% vs 9.7%; adjusted odds ratio 0.65; 95% confidence interval 0.54, 0.79). Other independent risk factors included living in the southern, western, or north central United States; preoperative comorbidity; and tobacco use.Conclusions: Approximately 6.9% of opioid-naive patients continued to fill opioid prescriptions 90 days after radical prostatectomy. The risk of persistent opioid use was significantly lower among patients undergoing a robot-assisted vs open approach. Further efforts are needed to develop postoperative opioid prescription protocols for patients undergoing radical prostatectomy.

Interactions between radical prostatovesiculectomy and diagnosis of prostate cancer

“…Bereits 2004 stellten etwa Su et al eine erste Kohorte von Patienten vor, bei denen ein nervschonendes Verfahren Anwendung fand [70]. Einigen Patienten heute besonders wichtige Aspekte und Wünsche -schnellere Rekonvaleszenz, kürzerer Krankenhausaufenthalt, reduzierter Schmerzmittelgebrauchwerden von der robotisch assistierten radikalen Prostatektomie fraglos erfüllt [71][72][73]. Um Vorteile im funktionellen Langzeitoutcome als gesichert anzuerkennen, dazu fehlen heute jedoch eindeutige Ergebnisse [74][75][76].…”

Long-acting liposomal bupivacaine and postoperative opioid use after Peyronie’s disease surgery: a pilot study

“…Postoperative opioid consumption, even in patients without a history of substance abuse, may lead to persistent use in up to 8% of patients (5)(6)(7)(8)(9). This has important implications when considering the vast overprescribing seen after urologic surgeries (27,28).…”

“…Several studies have specifically identified a positive correlation between postoperative opioid prescriptions, overdose, and new-onset dependence in patients without prior opioid exposure or substance abuse history (2)(3)(4). Among patients undergoing urologic procedures, the risk for prolonged opioid use is estimated at 2-9% (5)(6)(7)(8)(9).…”

Radical Prostatectomy: from Open Surgery towards Robotic Laparoscopy

“…В большом исследовании с участием более 12 000 пациентов Школяр и соавт. обнаружили, что длительное применение обезболивающих в группе РАРП было на 35 % ниже, чем у пациентов после открытой операции [49]. Не только значительно лучшая видимость за счет оптики, не имеющая себе равных среди хирургических микроскопов, теоретически способствует базовой защите основных анатомических структур, но также огромная подвижность операционных рычагов, которые с 360° свободой движения также не имеют аналогов Оригинальные исследования у других методов.…”