Background and Aims Robot-assisted laparoscopic radical prostatectomy (RALP) has replaced open prostatectomy. However, RALP does not reduce postoperative pain significantly compared to open prostatectomy. The acute pain response after laparoscopic surgery consists of a parietal and a visceral pain component. Although rectus sheath block (RSB) aids to control parietal pain originating from incision sites in abdominal surgeries, visceral analgesia should also be considered. We explored whether multimodal analgesia including intravenous dexmedetomidine and ketorolac reduced postoperative pain after RALP in patients receiving RSBs.
Methods The Ethics Committee of Seoul St. Mary’s Hospital approved this prospective, non-randomized observational study on August 10, 2020 (approval number: KC20OISI0520). All patients received ultrasound-guided RSBs preoperatively for analgesia after RALP. Multimodal analgesic drugs including intraoperative intravenous infusion of dexmedetomidine and ketorolac were administered in the study group (n = 30) but not in the control group (n
= 30). The pain scores and total postoperative opioid requirements were compared between the two groups until 24 h after surgery.
Results Demographic characteristics were comparable between the two groups. During surgery, patients in the study group were administered less remifentanil than controls. The study group showed significantly less pain scores during rest and coughing at 1 and 6 h after surgery, and less opioid requirements until the 24 h after surgery. The two groups were similar in all other postoperative characteristics.
Conclusions The multimodal analgesia (intravenous dexmedetomidine and ketorolac) improved postoperative analgesia after RALP in patients with RSBs. Further studies on various combinations of multimodal analgesics are needed to promote patient recovery.
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