Postoperative Pain, Recovery and Discharge Following Robot-assisted Laparoscopic Prostatectomy
Status:
Recruiting
Trial end date:
2022-12-01
Target enrollment:
Participant gender:
Summary
Prostate cancer is the commonest cancer form in men in Northern Europe. Management of the
cancer often includes surgical removal of the primary tumor. In the last 5-10 years, robot
assisted laparoscopic prostatectomy (RALP) has become common. Good pain relief is central to
early mobilization and greater patient satisfaction. Randomized controlled studies on pain
relief following RALP are few and the role of spinal analgesia in pain management following
robotic surgery has not been described. Techniques available for pain relief following RALP
include spinal anesthesia with or without opiates, intravenous analgesia with morphine or a
multimodal pain management technique using a combination of several analgesics. Spinal
anesthesia and analgesia reduces the surgical stress and inflammatory response following
laparoscopic colorectal surgery and may offer similar benefit even during RALP.
Early perioperative complications may cause postoperative morbidity following robotic
surgery, and sometimes delay home discharge. Since all robotic operations in the pelvic
region are performed in a deep Trendelenberg position, this can even have negative
consequences for the heart, brain and the lungs. Cardiac complications in the form of minimal
cardiac injury or mild heart failure have not been previously studied following RALP.
Additionally, patients are sometimes delirious in the early postoperative period following
RALP. The precise cause for this remains unclear and may be related to pain, cognitive
dysfunction or an urge to pass urine despite a urinary catheter.
In addition to good postoperative pain relief, early postoperative mobilization and home
discharge are important milestones in recovery of full function following major surgery. With
improvement in surgical technique, the time has come to evaluate if RALP can be performed on
an ambulatory basis. The main aims of this study are:
1. Can RALP be performed on an ambulatory basis and patients ready to be discharged home at
8 pm?
2. To determine if spinal anesthesia reduces pre-discharge pain intensity, stress response
and other perioperative side effects.
3. Is sufentanil or fentanyl the analgesic of choice when administered spinally together
with bupivacaine as an analgesic.
4. To determine the frequency and severity of cardiac and respiratory complications in the
steep Trendelenberg position during RALP.
5. To assess the quality of recovery, quality of life and activities of daily living
following ambulatory RALP?