Background and Aims The principle of minimising opiate use underpins Enhanced Recovery After Surgery (ERAS), with reduced post-operative morbidity and shorter length of hospital stay. In addition, evidence is increasingly suggestive that opiate use increases the risk of cancer disease recurrence.
Minimally-invasive surgical techniques are key, however the costs of robotic surgery can be prohibitive.
Many studies seeking to establish economic benefit of robotic surgery have looked at surgical outcomes, but little research focuses specifically on pain control.
This study assesses whether the introduction of a robotic service for colorectal cancer surgery improved patient outcomes with reduced post-operative pain and opiate use.
Methods Retrospective analysis of 41 robotic and 42 laparoscopic colorectal cancer surgeries with oxycodone or morphine Patient Controlled Analgesia (PCA) as the primary source of post-operative pain control. Ethics Committee approval sought and obtained. Primary outcomes were hours of PCA use and oxycodone-equivalent milligrams administered. Median and mean values calculated. Mann-Whitney U Test used to assess for statistical significance (p<0.05).
Results PCA use was significantly less following robotic surgery than laparoscopic surgery, both in terms of total opiate delivered (laparoscopic mean 88mg (median 55mg), robotic mean 54mg (median 40mg), p-value 0.002) and duration of PCA use (laparoscopic mean 46 hours (median 43 hours), robotic mean 65 hours (median 49 hours),p-value 0.001).
Conclusions This study indicates that a robotic approach in colorectal cancer surgery significantly reduces post-operative pain as measured by PCA usage, enhancing the ERAS programme and justifying its consideration in economic calculations for the introduction of a robotic service.
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