Pain management following robotic-assisted radical prostatectomy: transitioning to an opioid free regimen

Few studies demonstrate the safety and efficacy of postoperative pain regimens that exclude opioids altogether in patients undergoing robot-assisted radical prostatectomy (RARP). To reduce opioid use, we sought to develop an opioid-free regimen for RARP and determine perioperative outcomes before an...

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Bibliographic Details
Published in:Journal of robotic surgery 2021-12, Vol.15 (6), p.923-928
Main Authors: Prebay, Zachary J., Medairos, Robert, Landowski, Truman, Everett, Ross G., Doolittle, Johnathan, Kansal, Jagan K., Jacobsohn, Kenneth, Johnson, Scott C.
Format: Article
Language:English
Subjects:
Analgesics
Body mass index
Chronic pain
Continuity (mathematics)
Diabetes
Electronic health records
Emergency medical care
Hypertension
Kidney diseases
Length of stay
Medical records
Medicine
Medicine & Public Health
Minimally Invasive Surgery
Narcotics
Nonsteroidal anti-inflammatory drugs
Nursing
Original Article
Pain
Pain management
Patients
Prostate
Robotic surgery
Robotics
Surgery
Urological surgery
Urology
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Summary:Few studies demonstrate the safety and efficacy of postoperative pain regimens that exclude opioids altogether in patients undergoing robot-assisted radical prostatectomy (RARP). To reduce opioid use, we sought to develop an opioid-free regimen for RARP and determine perioperative outcomes before and after implementation. A retrospective, pre–post-interventional study was performed at a single institution between 8/2018 and 10/2019. An opioid-free pain regimen was developed and instituted on 3/7/2019, and all patients received preoperative counseling regarding pain expectations and management. Postoperative pain score was the primary outcome. Secondary outcomes included postoperative opioid use, length of stay, adverse events and unplanned health encounters within 30 days of discharge. Pearson’s chi-squared and Student’s t -tests were performed on categorical and continuous variables, respectively. Multivariable analysis was performed to determine risk factors for postoperative opioid use in the opioid-free cohort. A total of 89 patients were included for analysis; consisting of 47 (53%) pre-intervention and 42 (47%) post-intervention patients. Baseline characteristics were similar between groups. A significantly lower proportion of patients in the post-intervention group were administered opioids postoperatively (5% vs 53%, p  
ISSN:1863-2483
1863-2491
DOI:10.1007/s11701-021-01191-x