PROSPECT guidelines for postoperative pain management after radical prostatectomy
The PROSPECT working group of anaesthesiologists and surgeons provides clinicians with recommendations for postoperative pain management based on systematic review and critical appraisal of the available procedure-specific evidence in the context of multimodal peri-operative care pathways.
Adequate pain management is important for patients undergoing prostatectomy to enhance their recovery and avoid prolonged hospital stays (Joshi 2014; Tan 2015). Patients often experience moderate pain on movement after open radical prostatectomy, and although robot-assisted or laparoscopic surgery is typically less painful, trocar ports can give rise to parietal pain (d’Alonzo 2009; Woldu 2014).
A previous PROSPECT review (Joshi 2015) found limited evidence on which to base recommendations for managing pain after prostatectomy. However, with the introduction of new analgesic regimens and the more widespread use of robot surgery, a literature update was needed.
So, the PROSPECT working group developed updated recommendations to reflect the latest evidence, which were published in 2021:
PROSPECT guidelines update for evidence-based pain management after prostatectomy for cancer. Lemoine A, et al. Anaesth Crit Care Pain Med 2021;40:100922.
The overall recommendations for prostatectomy are shown in Table 1 and on the PROSPECT website.
*Use of systemic lidocaine contraindicates the simultaneous use of infiltration with local anaesthetics (Foo 2021). The duration of lidocaine infusion should be limited to the intraoperative and immediate postoperative periods for safety reasons.
†In the absence of intravenous lidocaine use.
Updates and ongoing PROSPECT work
The PROSPECT working group continues to work on new procedure reviews and updates to previous recommendations. Those nearly finalised include total knee arthroplasty (update), sternotomy, hip fracture, craniotomy, appendectomy, open abdominal hysterectomy (update), laparoscopic colectomy, and open colectomy (update). Other ongoing updates include open thoracotomy, laparoscopic cholecystectomy, and haemorrhoidectomy reviews.
Evidence and recommendations for all PROSPECT reviews (currently 20 surgical procedures) can be found on the website, esraeurope.org/prospect, together with links to all PROSPECT publications (most are open access).
The unique PROSPECT methodology is available at https://esraeurope.org/prospect-methodology/.
PROSPECT is supported by an unrestricted grant from the European Society of Regional Anaesthesia and Pain Therapy (ESRA) as an independent Working Group of the society.
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