MP27-10 POST-OPERATIVE PAIN MANAGEMENT AFTER RADICAL CYSTECTOMY: COMPARING TRADITIONAL AND ENHANCED RECOVERY AFTER SURGERY PROTOCOL AT USC

Abstract

INTRODUCTION AND OBJECTIVES: Opioids have traditionally been the mainstay of pain management after radical cystectomy (RC) for bladder cancer. Side effects of opioids include mental status changes, respiratory depression and ileus, which is the leading cause of prolonged hospital stay. The efficacy of opioid sparing analgesics after cystectomy, as a part of enhanced recovery after surgery (ERAS) protocol, has yet to be proven. We compare the amount of opioid use, pain score and postoperative ileus for consecutive ERAS and traditional patients after RC. METHODS: Using our IRB approved bladder cancer database, we retrospectively reviewed patients who underwent open RC using either traditional (Feb. 2010-Sept. 2013) or ERAS protocol (May 2012Dec. 2013) for pain management. Patients with a history of opioid use prior to surgery were excluded. Traditional protocol primarily used epidural and/or IV opioid analgesics including patient controlled analgesia, whereas ERAS protocol primarily used acetaminophen, ketorolac and local anesthetics through sub-fascial catheters with opioid analgesics reserved for breakthrough pain. 205 patients were ultimately enrolled (81: traditional, 124: ERAS). Opioid use and pain scores were analyzed and compared up to postoperative day 4. All routes of opioid use were recorded and converted to morphine equivalent dosage for comparison, and postoperative pain was recorded using VAS scale. Postoperative records were reviewed for incidence of ileus. RESULTS: Demographic data and results are presented in Table 1. CONCLUSIONS: Patients on ERAS protocol used significantly less opioid analgesics, which may have potentially contributed to decreased postoperative ileus and shorter lengths of hospital stay. Multi-institutional studies would be helpful to externally validate these results. Source of Funding: None