The effect of adjunct caudal block on postoperative analgesia in robot-assisted laparoscopic radical prostatectomy: A prospective randomized controlled, single blinded pilot study in a tertiary centre

Abstract

ObjectiveCaudal block provides satisfactory postoperative pain relief in lower abdominal operations. This pilot study explores its safety and effect on postoperative pain control in patients who underwent robot-assisted laparoscopic radical prostatectomy (RARP).MethodsFrom 2013 to 2014, 40 consecutive patients were randomized into two groups — one received caudal block using ropivacaine immediately after operation, the other received standard analgesia. Primary outcome measure was pain score based on 11-point Likert scale (0–10) recorded at recovery room, and at 6, 12, 24, 48, and 72 h after operation. All analgesic requirements, opioid-related adverse events and time to passage of flatus were examined.ResultsMean age of the two groups was similar (60.4 vs. 62.3 years, p = 0.33), as was American Society of Anaesthesiologists (ASA) class, body mass index (BMI) and operation times. No significant difference in median pain scores was reported in recovery room (2 vs. 3, p = 0.34), and at 6 h (2 vs. 2, p = 0.94), 12 h (0 vs. 0, p = 0.62), 24 h (1 vs. 0, p = 0.58), 48 h (1 vs. 0, p = 0.36) and 72 h (0 vs. 0, p = 0.78) postoperatively between control and caudal block groups, respectively. There was a higher mean opioid usage in the caudal block group which was not statistically significant. Although this was statistically insignificant while no significant difference in mean paracetamol usage was observed postoperatively. Median time to passage of flatus was similar (2.0 vs. 2.0 days, p = 0.97). There was one case of superficial wound infection and no opioid-related adverse events observed. Hospital stay was similar in both groups (2.5 vs. 2.5 days, p = 0.96).ConclusionAlthough a safe modality, caudal block in post RARP patients does not seem to improve pain control nor reduce analgesia requirements.

Ultrasound-guided paravertebral nerve block anesthesia for percutaneous endoscopic laser unroofing treatment of symptomatic simple renal cysts—An innovative ambulatory surgery mode

“…Enhanced recovery after surgery has become an important focus of perioperative management in many types of surgeries, including general surgery [ 19 ], orthopedics [ 20 ], and gynecologic oncological surgery [ 21 ]. Cystectomy is the most common enhanced recovery after surgery pathway performed in urology, due to a reduction in the rate of complications and the length of stay [ [22] , [23] , [24] ]. However, reported data about the development of ambulatory surgery programs in urologic diseases are limited.…”

A Comparative Study on Caudal Bupivacaine with and without Tramadol for Analgesia Postoperatively in Paediatric Inguino Scrotal Surgeries

“…Recently, various bupivacaine supplements have been used in many paediatric surgeries to increase the duration and quality of pain relief. Addition of tramadol to bupivacaine resulted in a dose-dependent upsurge in analgesia postoperatively [16][17] . This study showed a clinically and statistically substantial period of postoperatively pain reduction.…”

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

“…We do not recommend epidural analgesia despite positive studies published since January 2015 and before [10] because the technique is invasive and conveys a risk of side effects and complications such as hypotension, dural puncture and even epidural haematoma [56]. Caudal block is not recommended because only one negative study has been published on its use [26].…”