Robot-Assisted Simple Prostatectomy

Cockrell, Ross; Bonzo, Jeremy; Lee, David I.

doi:10.1089/end.2017.0715

Cited by 12 publications

(6 citation statements)

References 5 publications

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“…The principal skin wound created during laparoscopy-based surgery lies in the peri-umbilical area; the orifice is used for camera insertion and specimen (prostate mass) removal. In the past, RSB effectively countered pain caused by injury to the peri-umbilical dermatomes [ 26 , 27 ]. However, as surgery advanced from open surgery to human-executed laparoscopic surgery to RALP (reducing the operation time and numbers of painful stimuli delivered by surgical wounds in sites such as the umbilicus) [ 28 ], the analgesic effect of RSB seems to have gradually decreased along with improvements in surgical wound care techniques.…”

Section: Discussionmentioning

confidence: 99%

Comparison of analgesic efficacy between rectus sheath blockade, intrathecal morphine with bupivacaine, and intravenous patient-controlled analgesia in patients undergoing robot-assisted laparoscopic prostatectomy: a prospective, observational clinical study

et al. 2020

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Background We explored the analgesic outcomes on postoperative day (POD) 1 in patients undergoing robot-assisted laparoscopic prostatectomy (RALP) who received intravenous patient-controlled analgesia (IV-PCA), rectus sheath bupivacaine block (RSB), or intrathecal morphine with bupivacaine block (ITMB). Methods This was a prospective, observational clinical trial. Patients were divided into three groups: IV-PCA (n = 30), RSB (n = 30), and ITMB (n = 30). Peak pain scores at rest and with coughing, cumulative IV-PCA drug consumption, the need for IV rescue opioids, and Quality of Recovery-15 (QoR-15) questionnaire scores collected on POD 1 were compared among the groups. Results The preoperative and intraoperative findings were comparable among the groups; the ITMB group required the least remifentanil of all groups. During POD 1, the ITMB group reported lower levels of pain at rest and with coughing, compared with the other two groups. During POD 1, incidences of severe pain at rest (10.0% vs. 23.3% vs. 40.0%) and with coughing (16.7% vs. 36.7% vs. 66.7%) were the lowest in the ITMB group compared with the RSB and IV-PCA groups, respectively. After adjustment for age, body mass index, diabetes mellitus, hypertension, and intraoperative remifentanil infusion, severe pain at rest was 0.167-fold less common in the ITMB group than in the IV-PCA group, while pain with coughing was 0.1-fold lower in the ITMB group and 0.306-fold lower in the RSB group, compared with the IV-PCA group. The ITMB group required lower cumulative IV-PCA drug infusions and less IV rescue opioids, while exhibiting a better QoR-15 global score, compared with the other two groups. Complications (nausea and pruritus) were significantly more common in the ITMB group than in the other two groups; however, we noted no ITMB- or RSB-related anesthetic complications (respiratory depression, post-dural headache, nerve injury, or puncture site hematoma or infection), and all patients were assessed as Clavien-Dindo grade I or II during the hospital stay. Conclusion Although ITMB induced complications of nausea and pruritus, this analgesic technique provided appropriate pain relief that enhanced patient perception related to early postoperative recovery. Trial registration Clinical Research Information Service, Republic of Korea, (approval number: KCT0005040) on May 20, 2020

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Section: Discussionmentioning

confidence: 99%

Comparison of analgesic efficacy between rectus sheath blockade, intrathecal morphine with bupivacaine, and intravenous patient-controlled analgesia in patients undergoing robot-assisted laparoscopic prostatectomy: a prospective, observational clinical study

et al. 2020

View full text Add to dashboard Cite

show abstract

“…The principal skin wound created during laparoscopy-based surgery lies in the peri-umbilical area; the ori ce is used for camera insertion and specimen (prostate mass) removal. In the past, RSB effectively countered pain caused by injury to the peri-umbilical dermatomes [26,27]. However, as surgery advanced from open surgery to human-executed laparoscopic surgery to RALP (reducing the operation time and numbers of painful stimuli delivered by surgical wounds in sites such as the umbilicus) [28], the analgesic effect of RSB seems to have gradually decreased along with improvements in surgical wound care techniques.…”

Section: Discussionmentioning

confidence: 99%

Comparison of analgesic efficacy between rectus sheath blockade, intrathecal morphine with bupivacaine, and intravenous patient-controlled analgesia in patients undergoing robot-assisted laparoscopic prostatectomy: a prospective, observational clinical study

Shim

Cho

Kim

et al. 2020

Preprint

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Background: We explored the analgesic outcomes on postoperative day (POD) 1 in patients undergoing robot-assisted laparoscopic prostatectomy (RALP) who received intravenous patient-controlled analgesia (IV-PCA), rectus sheath bupivacaine block (RSB), or intrathecal morphine with bupivacaine block (ITMB). Methods: This was a prospective, observational clinical trial. Patients were divided into three groups: IV-PCA (n = 30), RSB (n = 30), and ITMB (n = 30). Peak pain scores at rest and with coughing, cumulative IV-PCA drug consumption, the need for IV rescue opioids, and Quality of Recovery-15 (QoR-15) questionnaire scores collected on POD 1 were compared among the groups.Results: The preoperative and intraoperative findings were comparable among the groups; the ITMB group required the least remifentanil of all groups. During POD 1, the ITMB group reported lower levels of pain at rest and with coughing, compared with the other two groups. During POD 1, incidences of severe pain at rest (10.0% vs. 23.3% vs. 40.0%) and with coughing (16.7% vs. 36.7% vs. 66.7%) were the lowest in the ITMB group compared with the RSB and IV-PCA groups, respectively. After adjustment for age, body mass index, diabetes mellitus, hypertension, and intraoperative remifentanil infusion, severe pain at rest was 0.167-fold less common in the ITMB group than in the IV-PCA group, while pain with coughing was 0.1-fold lower in the ITMB group and 0.306-fold lower in the RSB group, compared with the IV-PCA group. The ITMB group required lower cumulative IV-PCA drug infusions and less IV rescue opioids, while exhibiting a better QoR-15 global score, compared with the other two groups. Complications (nausea and pruritus) were significantly more common in the ITMB group than in the other two groups; however, we noted no ITMB- or RSB-related anesthetic complications (respiratory depression, post-dural headache, nerve injury, or puncture site hematoma or infection), and all patients were assessed as Clavien-Dindo grade I or II during the hospital stay.Conclusion: Although ITMB induced complications of nausea and pruritus, this analgesic technique provided appropriate pain relief that enhanced patient perception related to early postoperative recovery.Trial registration: Clinical Research Information Service, Republic of Korea, (approval number: KCT0005040) on May 20, 2020https://cris.nih.go.kr/cris/search/search_result_st01_kren.jsp?seq=15943&sLeft=2&ltype=my&rtype=my

show abstract

“…The principal skin wound created during laparoscopy-based surgery lies in the peri-umbilical area; the ori ce is used for camera insertion and specimen (prostate mass) removal. In the past, an RSB effectively countered pain caused by injury to the peri-umbilical dermatomes [18,19]. However, as surgery advanced from open surgery to human-executed laparoscopic surgery to RALP (reducing the operation time and numbers of painful stimuli delivered by surgical wounds in sites such as the umbilicus) [20], the analgesic effect of an RSB seems to have gradually decreased as surgical wound care techniques also improved.…”

Section: Discussionmentioning

confidence: 99%

Analgesic Efficacy of Rectus Sheath Bupivacaine and Intrathecal Morphine With Bupivacaine Compared to Intravenous Patient-controlled Analgesia in Males Undergoing Robot-Assisted Laparoscopic Prostatectomy: A Prospective, Observational Parallel-Cohort Study

Shim¹,

Cho²,

Kim³

et al. 2020

Preprint

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Background: We explored the analgesic outcomes on postoperative day (POD) 1 of males undergoing robot-assisted laparoscopic prostatectomy (RALP) who received intravenous (IV) patient-controlled analgesia (PCA), a rectus sheath bupivacaine block (RSB), or an intrathecal morphine with bupivacaine (ITMB) block. Methods: This was a prospective, observational parallel-cohort trial. Patients were divided into three groups: IV-PCA (n = 30), RSB (n = 30), and ITMB block (n = 30). Peak pain scores at rest and when coughing, cumulative IV-PCA drug consumption, the need for IV rescue opioids, and Quality of Recovery-15 (QoR-15) questionnaire scores collected on POD 1 were compared among the groups.Results: The preoperative and intraoperative findings were comparable among the groups; the ITMB block group required the least remifentanil of all groups. During POD 1, the ITMB block group reported lower levels of pain at rest and when coughing than did the other two groups. After adjustment for age, body mass index, comorbidities, and intraoperative remifentanil infusion, severe pain at rest was 0.167-fold less common in the ITMB block than in the IV-PCA group, and pain when coughing was 0.1-fold lower in the ITMB block group and 0.306-fold lower in the RSB group compared to the IV-PCA group. The ITMB block group required lower cumulative IV-PCA drug infusions and less IV rescue opioids, and exhibited a better QoR-15 global score than did the other two groups.Conclusion: An ITMB block seems to provide appropriate analgesia with tolerable complications and enhances early patient recovery after RALP.Trial registration: Clinical Research Information Service, Republic of Korea, (approval number: KCT0005040) on May 20, 2020https://cris.nih.go.kr/cris/search/search_result_st01_kren.jsp?seq=15943&sLeft=2&ltype=my&rtype=my

show abstract

Robot-Assisted Simple Prostatectomy

Abstract: Robotic-assisted simple prostatectomy is a feasible surgical approach for patients with a very enlarged prostate. Anastomosis of the bladder edge to the distal apical prostate margin can greatly reduce postoperative hematuria.

Cited by 12 publications

References 5 publications

Comparison of analgesic efficacy between rectus sheath blockade, intrathecal morphine with bupivacaine, and intravenous patient-controlled analgesia in patients undergoing robot-assisted laparoscopic prostatectomy: a prospective, observational clinical study

Comparison of analgesic efficacy between rectus sheath blockade, intrathecal morphine with bupivacaine, and intravenous patient-controlled analgesia in patients undergoing robot-assisted laparoscopic prostatectomy: a prospective, observational clinical study

Comparison of analgesic efficacy between rectus sheath blockade, intrathecal morphine with bupivacaine, and intravenous patient-controlled analgesia in patients undergoing robot-assisted laparoscopic prostatectomy: a prospective, observational clinical study

Analgesic Efficacy of Rectus Sheath Bupivacaine and Intrathecal Morphine With Bupivacaine Compared to Intravenous Patient-controlled Analgesia in Males Undergoing Robot-Assisted Laparoscopic Prostatectomy: A Prospective, Observational Parallel-Cohort Study

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