PD36-11 PROSPECTIVE RANDOMIZED COMPARISON OF PERIOPERATIVE PAIN CONTROL TO ENHANCE RECOVERY WITH RADICAL CYSTECTOMY

Abstract

You have accessJournal of UrologyCME1 Apr 2023PD36-11 PROSPECTIVE RANDOMIZED COMPARISON OF PERIOPERATIVE PAIN CONTROL TO ENHANCE RECOVERY WITH RADICAL CYSTECTOMY Isamu Tachibana, Amy McCutchan, Jacob Mcfadden, Adam Lemmon, Clint Cary, Hristos Kaimakliotis, Timothy Masterson, and Yar Yeap Isamu TachibanaIsamu Tachibana More articles by this author , Amy McCutchanAmy McCutchan More articles by this author , Jacob McfaddenJacob Mcfadden More articles by this author , Adam LemmonAdam Lemmon More articles by this author , Clint CaryClint Cary More articles by this author , Hristos KaimakliotisHristos Kaimakliotis More articles by this author , Timothy MastersonTimothy Masterson More articles by this author , and Yar YeapYar Yeap More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003334.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Enhanced Recovery After Surgery (ERAS) protocols have been increasingly implemented for perioperative care. Radical cystectomy with urinary diversion can have significant morbidity with analgesic control and return of bowel function. Our aim was to prospectively study the best perioperative pain regimen between thoracic epidural anesthesia (TEA), rectus sheath block (RSB), and surgeon infiltration (SI) with liposomal bupivacaine (LB) or standard bupivacaine (SB). METHODS: All patients were prospectively scheduled at Indiana University for cystectomy with diversion and randomized into four groups – TEA with bupivacaine/hydromorphone, RSB with LB, or SI with LB or SB. Visual Analog Scale (VAS) pain scores, opioid use, incidence of hypotension, nausea, sedation was compared between groups every 24 hours as well as time to first flatus, hospital length of stay were measured. Analysis of Variance (ANOVA) and link function testing was performed to assess significance between groups, with an alpha value of 0.05. RESULTS: We enrolled 160 patients with 40 in each group. Demographic and clinical characteristics are listed in Table 1 with no significant differences between groups. Table 2 lists outcomes of pain scores with no differences between regimens, although patients tended to use less opioids with a TEA (p=0.1 at 24 hrs, p=0.08 at 48 hrs, p=0.13 at 72 hrs, and p=0.34 at 96 hrs). Similar incidence of sedation, nausea, and hypotension were also seen between groups. Despite no significant difference with time to first flatus (p=0.32), length of stay was longer for patients with TEAs and shorter with RSB or SI with LB (p=0.02). CONCLUSIONS: In this randomized prospective study for perioperative pain control during radical cystectomy, TEA trended towards less opioid use whereas time to flatus and hospital length of stay was longer compared to RSB or SI. These various options may be tailored based on clinical scenario. Further studies may help improve all aspects of perioperative care to minimize morbidity. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e984 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Isamu Tachibana More articles by this author Amy McCutchan More articles by this author Jacob Mcfadden More articles by this author Adam Lemmon More articles by this author Clint Cary More articles by this author Hristos Kaimakliotis More articles by this author Timothy Masterson More articles by this author Yar Yeap More articles by this author Expand All Advertisement PDF downloadLoading ...