Prospective implementation of a nonopioid protocol for patients undergoing robot-assisted radical cystectomy with extracorporeal urinary diversion
| Autor: | François Audenet, Nikhil Waingankar, Kyrollis Attalla, Ketan K. Badani, Morgane Giordano, Alan Sim, John P. Sfakianos, Daniel M. Gainsburg, John Pfail, Marc A. Lubin |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Narcotic Urology medicine.medical_treatment NOP Population 030232 urology & nephrology Urinary Diversion Cystectomy Extracorporeal 03 medical and health sciences 0302 clinical medicine Clinical Protocols Robotic Surgical Procedures Anesthesia Conduction medicine Humans Pain Management Prospective Studies education Aged Retrospective Studies Analgesics Pain Postoperative education.field_of_study Bladder cancer business.industry Urinary diversion Perioperative Middle Aged medicine.disease Surgery Treatment Outcome Urinary Bladder Neoplasms Oncology 030220 oncology & carcinogenesis Feasibility Studies Female business |
| Zdroj: | Urologic Oncology: Seminars and Original Investigations. 37:300.e17-300.e23 |
| ISSN: | 1078-1439 |
| DOI: | 10.1016/j.urolonc.2019.02.002 |
| Popis: | To evaluate the feasibility and outcomes of a nonopioid (NOP) perioperative pain management protocol for patients undergoing robot-assisted radical cystectomy (RARC).We prospectively included 52 consecutive patients undergoing RARC at our institution for bladder cancer. Patients received a multimodal pain management protocol, including a combination of nonopioid pain medications and regional anesthesia. For comparison, we retrospectively included 41 consecutive patients who received the same procedure before implementation of the NOP protocol.There was no significant difference in demographic and perioperative characteristics between the two groups. Patients included in the NOP protocol received a much lower dose of postoperative morphine milligram equivalents (2.5 [IQR: 0-23] vs. 44 [14.5-128], P0.001), with no difference in pain scores. In the NOP protocol, the median time to regular diet was significantly shorter (4days [IQR: 3-5] vs. 5days [IQR: 4-8], P = 0.002) and the length of stay was 2days shorter compared to the control group (5days [IQR: 4-7] vs. 7days [IQR: 6-11], P0.001). When evaluating the direct costs within 30days after initial surgery, the NOP protocol was associated with an 8.6% reduction as compared to the control group (P = 0.032). In multivariate analysis, the receipt of the NOP protocol was a significant predictor of a length of stay7days after RARC (OR: 12.09; 95% CI: 1.70-140; P = 0.023).The prospective implementation of a NOP protocol for patients undergoing RARC is feasible, allowing for minimal narcotic usage and provides benefits to patients, institutions, and population. |
| Databáze: | OpenAIRE |
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