Spinal analgaesia is more effective than an intravenous opioid for decreasing postoperative pain in men undergoing a robot-assisted radical prostatectomy (RARP), according to results of a retrospective analysis presented here on March 26 at the 32nd Annual Congress of the European Association of Urology (EAU).
Lawrence Kim, MD, Royal Marsden Hospital NHS, London, United Kingdom, and colleagues compared data from 100 consecutive patients in a single institution who received intravenous opioid with data from 100 consecutive patients who received spinal analgaesia using intrathecal diamorphine as the primary analgesic modality.
The intrathecal diamorphine group had a consistently lower postoperative pain score than did the intravenous opioid group in the immediate postoperative period (2 vs 6, P < .01) and at 12 hours postoperatively (2 vs 5, P < .01), and at 24 hours postoperatively (1 vs 21, P = .06).
The total postoperative opioid requirement (morphine equivalent mg) was 0 mg (interquartile range [IQR] 0 to 0,) in the intrathecal diamorphine group compared with 6 mg (IQR 5 to 12) in the IV opioid group (P < .01).
The intravenous opioid group received 10 to 15 mg of morphine or a morphine equivalent intraoperatively. The intrathecal diamorphine group received 2 mL 0.5% bupivacaine plus 500 mcg of diamorphine.
Per the study protocol, all patients received 1 g of IV paracetamol, 100 mg of diclofenac unless contraindicated, and 1 L sodium lactate solution intraoperatively. For postoperative pain management, all patients received regular paracetamol 1g 4 times a day as required, codeine phosphate 60 mg 4 times a day, and oxybutynin 5 mg 3 times a day.
Clavien-Dindo complications (grades I to V) occurred in 4 (4%) patients from the intrathecal diamorphine group and 5 (5%) patients from the IV opioid group (P = .78).
Both treatment groups remained in hospital for a median of 2 days.
The 2 cohorts were similar with respect to age, body mass index, American Society of Anesthesiologists physical status, and preoperative Gleason score.
Intraoperative parameters were also similar in the 2 groups. The mean operative time was 122 ± 34 minutes for the intrathecal diamorphine group versus 132±23 minutes for the IV opioid group (P = .07). Eight patients (8%) in the intrathecal diamorphine group and 7 (7%) patients in the IV opioid group had an estimated blood loss of greater than 50 mL (P = .87). Forty-two patients (42%) and 45 patients (45%) in the 2 groups, respectively, had pelvic lymph-node dissection (P = .70).
“Our protocol has virtually eliminated the use of systemic opioids in patients undergoing robotic radical prostatectomy at our institution and, as such, is now standard practice at our facility,” Dr. Kim concluded.
While RARP may be associated with decreased pain levels compared with open surgery, abdominal and incisional pain remain, and may be severe.
Presentation title: Spinal Analgesia versus Intravenous Opioid for Robot-Assisted Radical Prostatectomy: A Retrospective analysis of 200 Cases. Abstract 595