Multidimensional comparison of acute postoperative pain and pain management following open and robotic-assisted radical prostatectomy for localised prostate cancer.

Abstract

BACKGROUND: Rapid advances in surgical approaches to radical prostatectomy (RP) require concurrent investigation of the implications of approach on patient experience. In particular, there is needed a better understanding of the quality and outcomes of postoperative pain management associated with open and minimally invasive techniques. METHODS AND RESULTS: We compared the outcomes of postoperative pain care in the first 24-hours following retropubic radical prostatectomy (RRP) (n = 209) and robotic-assisted prostatectomy (RARP) (n = 193) for localized prostate cancer. Overall, 31.8% of men had experienced a worst pain intensity (µ = 5.8/10, sd = 2.7) that was moderate-to-severe (pain ≥ 4/10) in the previous 24 hours. RARP patients had similar pain intensity to RRP patients however, RARP patients received less opiod equivalent analgesics (µ = 30.8mg, sd = 24.4mg) than RRP patients (µ = 44mg, sd = 30.7mg), (p <.001) and less of their available analgesics overall (23.4% vs. 29.8%), (p< .001). Typical location of pain was also different between groups. RRP was more likely to be associated with the surgical incision pain and RARP with pain consistent with insufflation of the peritoneum (lower abdominal and shoulder tip). DISCUSSION: Analyses identified distinct profiles of acute postoperative pain for RRP and RARP. Relatively high pain intensity ratings and differences in analgesic management between the two surgery types, suggest that the expectation of less pain associated with minimally invasive surgery may influence postsurgical pain treatment decision-making and care. These expectations may undermine the potential advantage of minimally invasive surgery.