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Background and Aims Radical robotic prostatectomy is increasingly popular. Our aim was to evaluate the analgesic requirements post radical robotic prostatectomy performed under general anaesthesia with caudal block.
Methods An audit was conducted between April 2008 and October 2018. 896 patients who underwent radical robotic prostatectomy received a standard general anaesthetic (paracetamol 1 gm, ondansetron 4mg, dexamethasone 6.6mg fentanyl 100microgram, propofol, desflurane and atracurium infusion) with caudal analgesia containing 40ml 0.25% bupivacaine, 150 micrograms clonidine and 100 micrograms fentanyl. Regular paracetamol was prescribed post-operatively, oral morphine 20mg 3 hourly, cyclizine and ondansetron were available on an ‘as required’ basis. Visual analogue scale (VAS) score, analgesic consumption and the incidence of side effects were recorded at 30 min and 24 hours post-surgery.
Results 24 (3%) patients required additional intraoperative morphine. Only 136 (15%)) had a VAS greater than 3/10 post-operatively with the highest being 8/10 in 8 patients. All patients received regular paracetamol. 148 (17%) required oral morphine within the first 24 hours post-operatively. Only 68 (8%) patients required intravenous morphine (10-20mg) in recovery. There were no major side effects associated with the caudal block. 112 (12.5%) suffered post-operative nausea and vomiting. Mean inpatient stay was 29.4hrs.
Conclusions A general anaesthetic with caudal block provides excellent intra- and post-operative analgesia with minimal side effects. This has important implications in terms of patient satisfaction, minimising side effects and facilitating early hospital discharge.
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