The effect of intrathecal bupivacaine/morphine on quality of recovery in robot‐assisted radical prostatectomy: a randomised controlled trial

Abstract

Summary Robot‐assisted radical prostatectomy causes discomfort in the immediate postoperative period. This randomised controlled trial investigated if intrathecal bupivacaine/morphine, in addition to general anaesthesia, could be beneficial for the postoperative quality of recovery. One hundred and fifty‐five patients were randomly allocated to an intervention group that received intrathecal 12.5 mg bupivacaine/300 μg morphine (20% dose reduction in patients > 75 years) or a control group receiving a subcutaneous sham injection and an intravenous loading dose of 0.1 mg.kg−1 morphine. Both groups received standardised general anaesthesia and the same postoperative analgesic regimen. The primary outcome was a decrease in the Quality of Recovery‐15 (QoR‐15) questionnaire score on postoperative day 1. The intervention group (n = 76) had less reduction in QoR‐15 on postoperative day 1; median (IQR [range]) 10% (1–8 [−60% to 50%]) vs. 13% (5–24 [−6% to 50%]), p = 0.019, and used less morphine during the admission; 2 mg (1–7 [0–41 mg]) vs. 15 mg (12–20 [8–61 mg]), p < 0.001. Furthermore, they perceived lower pain scores during exertion; numeric rating scale (NRS) 3 (1–6 [0–9]) vs. 5 (3–7 [0–9]), p = 0.001; less bladder spasms (NRS 1 (0–2 [0–10]) vs. 2 (0–5 [0–10]), p = 0.001 and less sedation; NRS 2 (0–3 [0–10]) vs. 3 (2–6 [0–10]), p = 0.005. Moreover, the intervention group used less rescue medication. Pruritus was more severe in the intervention group; NRS 4 (1–7 [0–10]) vs. 0 (0–1 [0–10]), p = 0.000. We conclude that despite a modest increase in the incidence of pruritus, multimodal pain management with intrathecal bupivacaine/morphine remains a viable option for robot‐assisted radical prostatectomy.

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

“…Our ITMB data are similar to those of previous laparoscopic and open surgery reports [ 5 , 22 – 24 ]; thus, ITMB is a feasible and practicable form of pain relief (yielding a lower pain score and lower opioid requirement). Moreover, it was not associated with serious complications (such as nerve injury) during or after surgery, and was better than RSB or IV-PCA alone.…”

“…This pain arises from skin-port incisions, multiple dissections of prostate-involved and surrounding tissues, bladder spasm, and transurethral catheter irritation [ 4 ]. Various central and/or peripheral pain-relief methods have been used to attenuate the severe pain that develops immediately after RALP [ 5 , 6 ]. A rectus sheath block (RSB) regimen affords peri-umbilical incision site analgesia superior to that achieved via local anesthetic infiltration; this site is the principal source of pain immediately after laparoscopy-based surgery [ 7 ].…”

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

“…In a gynecological study, the addition of intrathecal bupivacaine to intrathecal morphine signi cantly improved postoperative pain relief, but the addition of rectus sheath bupivacaine to intrathecal morphine did not afford additional analgesia [16]. A urological study suggested that multimodal pain control via intrathecal bupivacaine/morphine may optimally improve the quality of early recovery and reduce postoperative pain, being associated with less pain during exertion and fewer bladder spasms (compared to a control group) [5]. Our ITMB block data are similar to those of previous laparoscopic or open surgery reports [5,[14][15][16]; the ITMB block was a feasible and practicable form of pain relief, not associated with serious complications (such as nerve injury) during or after surgery, and was better than the RSB or IV-PCA alone.…”

“…However, RALP patients frequently experience considerable pain, particularly on the day after surgery, re ecting the skin-port incisions, multiple dissections of prostate-involved and surrounding tissues, bladder spasm, and transurethral catheter irritation [4]. Various central and/or peripheral pain-relief methods have been used to attenuate the severe pain that develops immediately after RALP [5,6]. A rectus sheath block (RSB) afforded peri-umbilical incision site analgesia superior to that achieved via local anesthetic in ltration; this site is the principal source of pain immediately after laparoscopy-based surgery [7].…”

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

“…This pain arises from skin-port incisions, multiple dissections of prostate-involved and surrounding tissues, bladder spasm, and transurethral catheter irritation [4]. Various central and/or peripheral pain-relief methods have been used to attenuate the severe pain that develops immediately after RALP [5,6]. A rectus sheath block (RSB) regimen affords peri-umbilical incision site analgesia superior to that achieved via local anesthetic in ltration; this site is the principal source of pain immediately after laparoscopy-based surgery [7].…”