Minimizing pain medication use and its associated costs following robotic surgery

• Published in: Gynecologic oncology 2017-01, Vol.144 (1), p.187-192
• Main Authors: Abitbol, Jeremie, Cohn, Rebecca, Hunter, Sandra, Rombaldi, Marcelo, Cohen, Eva, Kessous, Roy, Large, Nick, Reiss, Ari, Lau, Susie, Salvador, Shannon, Gotlieb, Walter H
• Format: Article
• Language: English
• Subjects: Acetaminophen - administration & dosage; Aged; Analgesia, Patient-Controlled - economics; Analgesics; Analgesics - administration & dosage; Analgesics - economics; Anti-Inflammatory Agents, Non-Steroidal - administration & dosage; Costs; Drug Costs; Electronic Health Records; Endometrial Neoplasms - surgery; Female; Hematology, Oncology and Palliative Medicine; Humans; Ibuprofen - administration & dosage; Middle Aged; Minimally Invasive Surgical Procedures - adverse effects; Morphine - administration & dosage; Naproxen - administration & dosage; Obstetrics and Gynecology; Pain; Pain, Postoperative - drug therapy; Retrospective Studies; Robotic surgery; Robotic Surgical Procedures - adverse effects
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2016.11.014

Abstract Introduction Minimally invasive surgery (MIS) has been associated with diminished postoperative pain and analgesia requirements. The objective of the current study was to evaluate the use of analgesia in the post-operative period following robotic surgery for endometrial cancer. Methods All consecutive patients who underwent robotic surgery for the treatment of endometrial cancer were included in this study. The timing, dose, and type of analgesics administered postoperatively were recorded from patients' electronic medical record. Data was compared to a matched historical cohort of patients who underwent laparotomy before the introduction of the robotic program. Results Only eight patients (2.4%, 5 during the first 25 cases and 3 following mini-laparotomy) received patient-controlled analgesia (PCA) following robotic surgery. Most patients' pain was alleviated by over-the-counter analgesics (acetaminophen, non-steroidal anti-inflammatories). In comparison to laparotomy, patients who underwent robotic surgery required significantly less opioids (71 mg vs. 12 mg IV morphine, p < 0.0001) and non-opioids (4810 mg vs. 2151 mg acetaminophen, 1892 vs. 377 mg ibuprofen, and 1470 mg vs. 393 mg naproxen; all p < 0.0001). Conclusion Patients require less analgesics (opioids and non-opioids) following robotic surgery in comparison to conventional laparotomy, including the elderly and the obese. The diminished pain medication use is associated with some cost savings.