Intraoperative multimodal analgesic bundle containing dexmedetomidine and ketorolac may improve analgesia after robot-assisted prostatectomy in patients receiving rectus sheath blocks

Jung Woo Shim, Eun Hwa Jun, Jinhoon Bae, Hyong Woo Moon, Sung Hoo Hong, Jaesik Park, Hyung Mook Lee, Sang Hyun Hong, Min Suk Chae

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Background: Minimally invasive robot-assisted laparoscopic radical prostatectomy (RALP) has replaced open prostatectomy. However, RALP does not reduce postoperative pain compared to the open approach. We explored whether bundled intraoperative intravenous infusion of dexmedetomidine and ketorolac reduced opioid requirements during the 24 h after RALP. Methods: Eighty patients (two parallel groups) were enrolled in this prospective non-randomized study from September 2020 to November 2020. All received preoperative rectus sheath blocks for analgesia after RALP. A multimodal analgesic bundle (dexmedetomidine and ketorolac) was administered intraoperatively in the study group (n = 39) but not in the control group (n = 40). The total postoperative opioid requirements (expressed in milligrams of intravenous morphine) and pain scores (derived using a visual analog scale) were compared between the two groups up to 24 h after surgery. Results: The two groups were demographically similar. During surgery, patients in the study group received less remifentanil and more ephedrine than controls. The study group required significantly less opioids during the 24 h after surgery (28.3 vs. 40.0 mg, p = 0.006). The between-group pain scores differed significantly at 1 and 6 h after surgery. All other postoperative characteristics were comparable between the two groups. Conclusions: The intraoperative multimodal analgesic bundle (intravenous dexmedetomidine and ketorolac) improved postoperative analgesia after RALP in patients with rectus sheath blocks, as evidenced by the opioid-sparing effect after surgery.

Original languageEnglish
Pages (from-to)860-866
Number of pages7
JournalAsian Journal of Surgery
Volume45
Issue number3
DOIs
StatePublished - Mar 2022

Bibliographical note

Publisher Copyright:
© 2021

Keywords

  • Intraoperative multimodal analgesia
  • Postoperative pain
  • Robotic-assisted prostatectomy

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