Beitragstitel | Does continuous local anesthetic wound infiltration for postoperative pain management improve surgical recovery after radical cystectomy? |
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Beitragscode | M011 |
Autor:innen | |
Präsentationsform | Freie Mitteilungen |
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Abstract-Text |
Introduction & objectives Radical cystectomy (RC) is a major urological operation with a high morbidity rate, despite dedicated perioperative programs of rehabilitation. Traditionally postoperative pain management was achieved with epidural catheter. However, its use could lead to anesthesiologic complication and could reduce early mobilization, a cornerstone of the enhanced early recovery protocol (ERAS®). The present study aimed to evaluate the impact of an alternative anesthetic infusion on postoperative recovery in patients treated with RC. Methods Since June 2016, patients who underwent elective RC received the ON-Q® Pain Buster, which infused 0.2 % Ropivacaine via an elastomeric pump into the subfascial aspects of the wound as postoperative analgesia modality. Verbal analog pain score and recovery data on postoperative complication and length of stay (LOS) were investigated. Study population was matched to a control group of patients managed with epidural catheter analgesia before 2016. All patients were treated according to ERAS® guidelines for RC. Results In this preliminary report, 26 patients were included and compared to 51 patients in control group. Demographics and oncological outcomes were comparable in both group. In logistic regression analysis, patient pain evaluations from postoperative day (POD) 0 to POD 5 were similar in both groups. Furthermore, oral pain control was achieved in 4 days (IQR 4-6) in the study group versus 5 days (IQR 4-7) in the controls (p = 0.02). Patients with a Pain Buster could significantly faster tolerate solid food intake than those in the epidural group (5 days versus 11 days respectively, p = 0.001) and their LOS was 4 days, shorter than the control group (14 days versus 18 days respectively, p = 0.001). No significant difference wad found regarding readmission rate and major complication rate. Conclusion Continuous wound infiltration seems to have similar results as epidural catheter in terms of postoperative pain management in radical cystectomy patients. This technique may also have an impact in reducing LOS and accelerating solid food intake. |