Abstract
Purpose
Laparoscopy (LSC) offers superior patient outcomes compared to laparotomy. Small retrospective/prospective series have suggested robotics offers further reduction in postoperative pain and pain medication use compared to standard LSC. Our objective was to compare postoperative pain in patients undergoing robotically assisted (RBT) versus standard LSC for newly diagnosed endometrial cancer.
Methods
All preoperative endometrial cancer cases scheduled for RBT and LSC from May 1, 2007 to June 9, 2010 were identified. For this analysis, we only included cases not requiring conversion to laparotomy. All patients were offered intravenous (IV) patient-controlled analgesia (PCA) postoperatively. Intraoperative equivalent fentanyl doses (IEFDs) and pain scores in the postanesthesia care unit (PACU) were assessed.
Results
IV PCA was used in 206 RBTs (86 %) and 208 LSCs (88 %). Median IEFD was 425 μg for LSCs and 500 μg for RBTs (P = 0.03). Median pain scores on PACU arrival were similar in both groups. Median highest pain score was 5 for LSCs and 4 for RBTs (P = 0.007). Linear regression demonstrated that the IEFD was not correlated with the highest pain score (R = 0.09; P = 0.07). Fentanyl was used postoperatively in 196 of 206 RBTs (95 %) and 187 of 208 LSCs (90 %). The total fentanyl doses were 242.5 (range 0–2705) μg and 380 (range 0–2625) μg, respectively (P < 0.001). The median hourly fentanyl doses were 16.7 (range 0–122.5) μg and 23.5 (range 0–132.4) μg, respectively (P = 0.005). Simultaneous multiple regression analysis further demonstrated RBT was independently associated with a lower total fentanyl dose compared to LSC (P = 0.02).
Conclusions
RBT is independently associated with significantly lower postoperative pain and pain medication requirements compared to LSC. The amount of intraoperative fentanyl analgesia does not appear to correlate with postoperative pain.
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Disclosure
Dr. Leitao is a consultant for Intuitive Surgical. Dr. Jewell is an educational speaker for Covidien. The other authors declare no conflict of interest.
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Leitao, M.M., Malhotra, V., Briscoe, G. et al. Postoperative Pain Medication Requirements in Patients Undergoing Computer-Assisted (“Robotic”) and Standard Laparoscopic Procedures for Newly Diagnosed Endometrial Cancer. Ann Surg Oncol 20, 3561–3567 (2013). https://doi.org/10.1245/s10434-013-3064-9
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DOI: https://doi.org/10.1245/s10434-013-3064-9