Postoperative Analgesia after Radical Retropubic Prostatectomy

Abstract

Background: Postoperative pain after radical retropubic pros- tatectomy can be severe unless adequately treated. Low thoracic epidural analgesia and patient-controlled intravenous analgesia were compared in this double-blind, randomized study. Methods: Sixty patients were randomly assigned to receive either low thoracic epidural analgesia (group E) or patient- controlled intravenous analgesia (group P) for postoperative pain relief. All patients had general anesthesia combined with thoracic epidural analgesia during the operation. Postopera- tively, patients in group E received an infusion of 1 mg/ml ropivacaine, 2 ? g/ml fentanyl, and 2 ? g/ml adrenaline, 10 ml/h during 48 h epidurally, and a placebo patient-controlled intra- venous analgesia pump intravenously. Patients in group P re- ceived a patient-controlled intravenous analgesia pump with morphine intravenously and 10 ml/h placebo epidurally. Pain, the primary outcome variable, was measured using the numeric rating scale at rest (incision pain and “deep” visceral pain) and on coughing. Secondary outcome variables included gastroin- testinal function, respiratory function, mobilization, and full recovery. Health-related quality of life was measured using the Short Form-36 questionnaire, and plasma concentration of fen- tanyl was measured in five patients to exclude a systemic effect of fentanyl. Results: Incisional pain and pain on coughing were lower in group E compared with group P at 2–24 h, as was deep pain between 3 and 24 h postoperatively (P < 0.05). Maximum ex- piratory pressure was greater in group E at 4 and 24 h (P<0.05) compared with group P. No difference in time to home dis- charge was found between the groups. The mean plasma fent- anyl concentration varied from 0.2 to 0.3 ng/ml during 0–48 h postoperatively. At 1 month, the scores on emotional role, physical functioning, and general health of the Short Form-36 were higher in group E compared with group P. However, no group ? time interaction was found in the Short Form-36. Conclusions: The authors found evidence for better pain re- lief and improved expiratory muscle function in patients re- ceiving low thoracic epidural analgesia compared with patient-controlled analgesia for radical retropubic prostatectomy. Low thoracic epidural analgesia can be recommended as a good method for postoperative analgesia after abdominal surgery.