Scheduled intravenous ketorolac is safe and reduces narcotic use after robotic-assisted simple prostatectomy.
Humans
Ketorolac
/ administration & dosage
Prostatectomy
/ methods
Robotic Surgical Procedures
/ methods
Male
Pain, Postoperative
/ prevention & control
Retrospective Studies
Middle Aged
Aged
Anti-Inflammatory Agents, Non-Steroidal
/ administration & dosage
Administration, Intravenous
Analgesics, Opioid
/ administration & dosage
Narcotics
/ administration & dosage
Length of Stay
/ statistics & numerical data
Treatment Outcome
Prostatic Neoplasms
/ surgery
Minimally invasive surgery
Prostatectomy
Robotics
Journal
Journal of robotic surgery
ISSN: 1863-2491
Titre abrégé: J Robot Surg
Pays: England
ID NLM: 101300401
Informations de publication
Date de publication:
03 Oct 2024
03 Oct 2024
Historique:
received:
07
03
2023
accepted:
27
07
2024
medline:
3
10
2024
pubmed:
3
10
2024
entrez:
3
10
2024
Statut:
epublish
Résumé
We sought to examine whether scheduled intravenous (IV) ketorolac decreased post-operative narcotic utilization and changed peri-operative outcomes (including complications) in patients undergoing robotic-assisted simple prostatectomy (RASP). An IRB-approved, retrospective chart review was performed of all patients undergoing RASP at a single institution from November 2017 to July 2019. Patient demographic, peri-operative, and post-operative data, including morphine equivalent use (MEU), were collected. Scheduled ketorolac use was implemented at the surgeon's discretion for up to 5 days post-operatively. The primary outcome was MEU in the post-operative stay. Two hundred seven men underwent RASP during the study period, of which 143 (69%) received scheduled ketorolac. No differences in patient demographics, prostate size, prior opioid utilization, or operative characteristics were identified between groups. Median MEU was significant less (5 vs 15, p < 0.001) in patients receiving scheduled ketorolac. Significantly more patients receiving scheduled ketorolac did not require the use of any narcotic during hospitalization (30% vs 11%, p = 0.005). On multivariable linear regression adjusted for age, BMI, prior opioid use, and length of stay, ketorolac use independently associated with decreased narcotic use (p = 0.003). No significant difference in transfusion rates were identified (3.5% vs. 1.6%, p = 0.44). Scheduled ketorolac is effective in reducing post-operative, in-hospital opioid utilization without increasing morbidity after RASP. Almost a third of patients on scheduled ketorolac did not require any opioids post-operatively.
Identifiants
pubmed: 39361167
doi: 10.1007/s11701-024-02068-5
pii: 10.1007/s11701-024-02068-5
doi:
Substances chimiques
Ketorolac
YZI5105V0L
Anti-Inflammatory Agents, Non-Steroidal
0
Analgesics, Opioid
0
Narcotics
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
358Informations de copyright
© 2024. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.
Références
Roehrborn CG (2005) Benign prostatic hyperplasia: an overview. Rev Urol 7(Suppl 9):S3–S14
pubmed: 16985902
pmcid: 1477638
Speakman M, Kirby R, Doyle S et al (2015) Burden of male lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) - focus on the UK. BJU Int 115:508–519
doi: 10.1111/bju.12745
pubmed: 24656222
Hong SJ, Ko WJ, Kim SI et al (2003) Identification of baseline clinical factors which predict medical treatment failure of benign prostatic hyperplasia: an observational cohort study. Eur Urol 44:94–99
doi: 10.1016/S0302-2838(03)00199-4
pubmed: 12814681
Yang Q, Peters TJ, Donovan JL et al (2001) Transurethral incision compared with transurethral resection of the prostate for bladder outlet obstruction: a systematic review and meta-analysis of randomized controlled trials. J Urol 165:1526–1532
doi: 10.1016/S0022-5347(05)66342-2
pubmed: 11342911
McCullough TC, Heldwein FL, Soon SJ et al (2009) Laparoscopic versus open simple prostatectomy: an evaluation of morbidity. J Endourol 23:129–133
doi: 10.1089/end.2008.0401
pubmed: 19119803
Autorino R, Zargar H, Mariano MB et al (2015) Perioperative outcomes of robotic and laparoscopic simple prostatectomy: a European-American multi-institutional analysis. Eur Urol 68:86–94
doi: 10.1016/j.eururo.2014.11.044
pubmed: 25484140
Sorokin I, Sundaram V, Singla N et al (2017) Robot-assisted versus open simple prostatectomy for benign prostatic hyperplasia in large glands: a propensity score-matched comparison of perioperative and short-term outcomes. J Endourol 31:1164–1169
doi: 10.1089/end.2017.0489
pubmed: 28854815
Manchikanti L, Helm S, Fellows B et al (2012) Opioid epidemic in the United States. Pain Phys 15:ES9-38
doi: 10.36076/ppj.2012/15/ES9
Ben-David B, Swanson J, Nelson JB et al (2007) Multimodal analgesia for radical prostatectomy provides better analgesia and shortens hospital stay. J Clin Anesth 19:264–268
doi: 10.1016/j.jclinane.2006.12.003
pubmed: 17572320
Sun EC, Darnall BD, Baker LC et al (2016) Incidence of and risk factors for chronic opioid use among opioid-naive patients in the postoperative period. JAMA Intern Med 176:1286–1293
doi: 10.1001/jamainternmed.2016.3298
pubmed: 27400458
pmcid: 6684468
Collins SL, Moore RA, McQuay HJ et al (2000) Single dose oral ibuprofen and diclofenac for postoperative pain. Cochrane Database Syst Rev 2:CD001548
Huang JJ, Taguchi A, Hsu H et al (2001) Preoperative oral rofecoxib does not decrease postoperative pain or morphine consumption in patients after radical prostatectomy: a prospective, randomized, double-blinded, placebo-controlled trial. J Clin Anesth 13:94–97
doi: 10.1016/S0952-8180(01)00219-7
pubmed: 11331167
Mazaris EM, Varkarakis I, Chrisofos M et al (2008) Use of nonsteroidal anti-inflammatory drugs after radical retropubic prostatectomy: a prospective, randomized trial. Urology 72:1293–1297
doi: 10.1016/j.urology.2007.12.039
pubmed: 18329071
Serretta V, Morgia G, Fondacaro L et al (2002) Open prostatectomy for benign prostatic enlargement in southern Europe in the late 1990s: a contemporary series of 1800 interventions. Urology 60:623–627
doi: 10.1016/S0090-4295(02)01860-5
pubmed: 12385922
Patel ND, Parsons JK (2014) Robotic-assisted simple prostatectomy: is there evidence to go beyond the experimental stage? Curr Urol Rep 15:443
doi: 10.1007/s11934-014-0443-0
pubmed: 25118852
Johnson B, Sorokin I, Singla N et al (2018) Determining the learning curve for robot-assisted simple prostatectomy in surgeons familiar with robotic surgery. J Endourol 32:865–870
doi: 10.1089/end.2018.0377
pubmed: 30062904
Brummett CM, Waljee JF, Goesling J et al (2017) New persistent opioid use after minor and major surgical procedures in US adults. JAMA Surg 152:e170504
doi: 10.1001/jamasurg.2017.0504
pubmed: 28403427
pmcid: 7050825
Xu W, Daneshmand S, Bazargani ST et al (2015) Postoperative pain management after radical cystectomy: comparing traditional versus enhanced recovery protocol pathway. J Urol 194:1209–1213
doi: 10.1016/j.juro.2015.05.083
pubmed: 26021824
Gridley C, Robles J, Calvert J et al (2020) Enhanced recovery after surgery protocol for patients undergoing ureteroscopy: prospective evaluation of an opioid-free protocol. J Endourol 34:647–653
doi: 10.1089/end.2019.0552
pubmed: 31928086
Chau DL, Walker V, Pai L et al (2008) Opiates and elderly: use and side effects. Clin Interv Aging 3:273–278
doi: 10.2147/CIA.S1847
pubmed: 18686750
pmcid: 2546472
Shlobin NA, Rosenow JM (2022) Nonopioid postoperative pain management in neurosurgery. Neurosurg Clin N Am 33:261–273
doi: 10.1016/j.nec.2022.02.004
pubmed: 35718395
Barber FA, Gladu DE (1998) Comparison of oral ketorolac and hydrocodone for pain relief after anterior cruciate ligament reconstruction. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 14:605–612
doi: 10.1016/S0749-8063(98)70057-X
Gopalraju P, Lalitha RM, Prasad K et al (2014) Comparative study of intravenous tramadol versus ketorolac for preventing postoperative pain after third molar surgery–a prospective randomized study. J Cranio-Maxillo-fac Surg Off Publ Eur Assoc Cranio-Maxillo-fac Surg 42:629–633
doi: 10.1016/j.jcms.2013.09.004
Schlachta CM, Burpee SE, Fernandez C et al (2007) Optimizing recovery after laparoscopic colon surgery (ORAL-CS): effect of intravenous ketorolac on length of hospital stay. Surg Endosc 21:2212–2219
doi: 10.1007/s00464-007-9335-4
pubmed: 17440782
Diblasio CJ, Snyder ME, Kattan MW et al (2004) Ketorolac: safe and effective analgesia for the management of renal cortical tumors with partial nephrectomy. J Urol 171:1062–1065
doi: 10.1097/01.ju.0000109961.69936.8e
pubmed: 14767271
Chow GK, Fabrizio MD, Steer T et al (2001) Prospective double-blind study of effect of ketorolac administration after laparoscopic urologic surgery. J Endourol 15:171–174
doi: 10.1089/089277901750134502
pubmed: 11325088
Singer AJ, Mynster CJ, McMahon BJ (2003) The effect of IM ketorolac tromethamine on bleeding time: a prospective, interventional, controlled study. Am J Emerg Med 21:441–443
doi: 10.1016/S0735-6757(03)00100-1
pubmed: 14523887
Fitzgerald GA (2004) Coxibs and cardiovascular disease. N Engl J Med 351:1709–1711
doi: 10.1056/NEJMp048288
pubmed: 15470192
Gobble RM, Hoang HLT, Kachniarz B et al (2014) Ketorolac does not increase perioperative bleeding: a meta-analysis of randomized controlled trials. Plast Reconstr Surg 133:741–755
doi: 10.1097/01.prs.0000438459.60474.b5
pubmed: 24572864