Personalized opioid-sparing pain relief protocol for advanced robot-assisted pelvic surgery

Abstract

The objective was to study the safety and efficacy of a personalized opioid-sparing pain relief protocol in the context of enhanced rehabilitation after advanced robot-assisted pelvic surgery.Materials and methods. The prospective study included 19 patients who underwent surgery under combined thoracic epidural anesthesia/analgesia: general anesthesia was administered with propofol or sevoflurane/desflurane with ketamine + 6–8 ml/hour of 0.25% ropivacaine, in the postoperative period 0.125% bupivacaine was administered at a rate of 8–15 ml/hour. In the comparison group (n = 21), opioids were used as a component of general anesthesia and multimodal analgesia. Intra- and postoperative opioid consumption, pain severity, opioid-related side effects, and timing of postoperative rehabilitation were evaluated.Results. In the study group, the median milligram equivalents of morphine were significantly lower than in the control group (103 versus 148 and 91 versus 404, respectively; p = 0.001 for both comparisons). The values of the numerical pain scale did not differ significantly between the groups. Side effects were significantly lower in the treatment group (26% vs. 62%; p = 0.026). There were significant differences in the timing of intestinal function recovery, initiation of regular diet and transfer from the recovery room in favor of opioid-sparing pain relief (p = 0.037; p = 0.046; and p = 0.023; respectively).Conclusions. The use of a personalized opioid-sparing pain relief protocol in the context of enhanced rehabilitation of patients underwent the advanced robot-assisted pelvic surgery helped to reduce opioid consumption, side effects, and postoperative rehabilitation without affecting the severity of pain.

Keywords

• robotic-assisted surgery
• opioid-sparing analgesia
• thoracic epidural anesthesia/analgesia
• opioid consumption
• enhanced rehabilitation