Prospective implementation of a nonopioid protocol for patients undergoing robot-assisted radical cystectomy with extracorporeal urinary diversion

Abstract

ObjectivesTo evaluate the feasibility and outcomes of a nonopioid (NOP) perioperative pain management protocol for patients undergoing robot-assisted radical cystectomy (RARC). Materials and MethodsWe prospectively included 52 consecutive patients undergoing RARC at our institution for bladder cancer. Patients received a multimodal pain management protocol, including a combination of nonopioid pain medications and regional anesthesia. For comparison, we retrospectively included 41 consecutive patients who received the same procedure before implementation of the NOP protocol. ResultsThere was no significant difference in demographic and perioperative characteristics between the two groups. Patients included in the NOP protocol received a much lower dose of postoperative morphine milligram equivalents (2.5 [IQR: 0–23] vs. 44 [14.5–128], P < 0.001), with no difference in pain scores. In the NOP protocol, the median time to regular diet was significantly shorter (4days [IQR: 3–5] vs. 5days [IQR: 4–8], P = 0.002) and the length of stay was 2days shorter compared to the control group (5days [IQR: 4–7] vs. 7days [IQR: 6–11], P < 0.001). When evaluating the direct costs within 30days after initial surgery, the NOP protocol was associated with an 8.6% reduction as compared to the control group (P = 0.032). In multivariate analysis, the receipt of the NOP protocol was a significant predictor of a length of stay <7days after RARC (OR: 12.09; 95% CI: 1.70–140; P = 0.023). ConclusionsThe prospective implementation of a NOP protocol for patients undergoing RARC is feasible, allowing for minimal narcotic usage and provides benefits to patients, institutions, and population.