E Worwag, GW Chodak
Overnight Hospitalization After Radical Prostatectomy : The impact of two pathways on patient satisfaction, Length of Hospitalization and Morbidity.
Anesth analg 87 62-67, 1998
Emphasis on cost control has spurred attempts to decrease hospital stays. The efficacy of overnight hospitalization for radical prostatectomy using complications and patient satisfaction as measures were reported for 100 consecutive patients.
A standard retropubic radical prostatectomy was performed on all patients under epidural anesthesia followed by epidural morphine [ n=47] or combined spinal anesthesia using bupivacaine and fentanyl followed by 10 to 20 mg of IM methadone [n=53]. Length of hospital stay, postsurgical morbidity and patient satisfaction were compared.
Duration of surgery was significantly longer for the methadone group as compared to the morphine group. The median period of hospital stay was same for both groups [ 1.2 to 1.34 days]. Only 17% of the patients stayed longer than one night. There were no complications attributable to surgery, anesthesia or analgesia. Only 21% of patients believed their stay was too short.
A Gottschalk, DS Smith, DR Jobes, et al
Preemptive Epidural Analgesia and Recovery from Radical Prostatectomy : A Randomised Controlled Trial
JAMA 279 : 1076-1082, 1998
Pain perception can be decreased by inhibiting CN S sensitization before the painful stimulus is introduced. However, whether such preemptive analgesia has proven clinical efficacy is a matter of controversy. The authors compared postoperative pain and other outcome measures after radical prostatectomy in patients who either did or did not receive preemptive analgesia.
Ninety patients scheduled for radical prostatectomy to treat prostate cancer who had no neurological impairment, chronic painful condition or cardiovascular conditions were enrolled. Before general anesthesia was induced, all patients had an epidural catheter placed to allow postoperative analgesia. The patients were divided into a control group that did not receive any preopereative epidural analgesia and a group that received preoperative epidural analgesia with fentanyl and a group that received preoperative epidural bupivacaine. The drugs were administered throughout surgery in the two active treatment groups, and all patients, received aggressive postoperative epidural analgesia. Patients reported pain scores on a visual analog scale each day while hospitalized. They were also followed up for upto 9.5 weeks after surgery to assess general health, pain and activity levels.
Postoperative pain control after preoperative fentanyl and bupivacaine did not differ significantly and thus these two groups were combined for consideration. Compared with the placebo group patients who received preemptive analgesia had 33% less pain during hospitalisation, starting from the first day after surgery. None of the groups differed significantly in the time of attainment of discharge milestone, pulmonary infection or in complication rates. Patients receiving preemptive analgesia were significantly more active at 3.5 weeks but activity levels did not differ significantly in the two groups by 5.5 to 9.5 weeks; but by 9.5 weeks patients receiving preemptive analgesia had significantly lower pain scores than the placebo group: 86% of the former and 47% of the latter reporting no pain at all.
Preoperative epidural analgesia significantly reduced postoperative pain till well after discharge and helped patients resume normal activities earlier.