Implementation of a nonopioid protocol following robot-assisted radical cystectomy with intracorporeal urinary diversion.

Autor: Pfail JL; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: John.Pfail@icahn.mssm.edu., Garden EB; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY., Gul Z; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY., Katims AB; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY., Rosenzweig SJ; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY., Razdan S; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY., Omidele O; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY., Nathaniel S; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY., Loftus K; Department of Anesthesiology, Perioperative and Pain Medicine, Icahn school of Medicine at Mount Sinai, New York, NY., Sim A; Department of Anesthesiology, Perioperative and Pain Medicine, Icahn school of Medicine at Mount Sinai, New York, NY., Mehrazin R; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY., Wiklund PN; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY., Sfakianos JP; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY.
Jazyk: angličtina
Zdroj: Urologic oncology [Urol Oncol] 2021 Jul; Vol. 39 (7), pp. 436.e9-436.e16. Date of Electronic Publication: 2021 Jan 23.
DOI: 10.1016/j.urolonc.2021.01.002
Abstrakt: Purpose: The implementation of robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) for management of patients with muscle-invasive or high-risk noninvasive bladder cancer has increased in utilization over the last decade. Here, we seek to describe institutional opioid prescription and utilization patterns following implementation of a nonopioid (NOP) perioperative pain management protocol in patients who received RARC with ICUD.
Materials and Methods: The records of all patients who underwent RARC that utilized a NOP perioperative pain management protocol at a single academic institution from 2016 to 2020 were retrospectively reviewed. Descriptive statistical analyses were performed. For comparison, we included 74 consecutive patients who received the same NOP protocol with extracorporeal urinary diversion (ECUD).
Results: A total of 116 patients who received ICUD were included in our analysis. The median operation time for the ICUD group was 305 minutes (interquartile range [IQR]: 262-352). 12.1% (n = 14) of patients who underwent ICUD required narcotics during inpatient hospitalization. For these patients, the median morphine milligram equivalent requirement was 52.0 (IQR: 7.62-157). Additionally, only 12.1% (n = 14) of patients were prescribed opioids postoperatively at discharge. We identified that within 6 months of surgery only 5 (4.3%) patients required a second narcotic prescription. Furthermore, of patients who did not use mu-opioid blockers, a minority experienced postoperative ileus (15.7%, n = 16). 30- and 90-day all Clavien complication rates for patients were 44.8% (n = 52) and 49.1% (n = 57), respectively. Nineteen (16.4%) patients were readmitted within 30 days of discharge, of which none were pain related. When compared to ECUD, patients who received ICUD experienced similar complication and readmission rates.
Conclusions: The implementation of a NOP protocol for patients undergoing RARC with ICUD allows for both decreased postoperative narcotic use and reduced need for narcotic prescriptions at discharge with acceptable complication and readmission rates.
(Copyright © 2021 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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