Prostatectomy 2020

Prostatectomy-specific evidence

Data table: Paracetamol and NSAIDs/COX-2-selective inhibitors for pain management after prostatectomy

Arguments for…

• Open prostatectomy: One study showed reduced cumulative opioid consumption (24%) and decreased pain intensity with postoperative parecoxib vs placebo (Dirkmann 2015).
• From the previous review (Joshi 2015), in open prostatectomy:
  • Of three additional studies comparing NSAIDs/COX-2-selective inhibitors with placebo, two studies found a reduction in pain scores at rest and in opioid use (Bilgin 2011; Chelly 2011); one study found no significant difference (Huang 2001).
  • Another study found a reduction in pain scores at rest with lornoxicam vs paracetamol (Mazaris 2008).

Arguments against…

• Robot-assisted prostatectomy: One study found no difference in opioid use and pain scores between paracetamol and placebo, but the length of hospital stay was reduced in the paracetamol group (Wang 2019).
• From the previous review (Joshi 2015), in open prostatectomy:
  • One study found no significant difference in pain scores between aspirin and tiaprofenic acid (Ormiston 1981).

PROSPECT Recommendations

• Systemic analgesia should include paracetamol and selective or non-selective NSAIDs administered pre-operatively or intra-operatively and continued postoperatively.
  • NSAIDs and COX-2-selective inhibitors lowered postoperative pain scores and opioid use (Dirkmann 2015; Mazaris 2008; Bilgin 2011; Chelly 2011).
  • Paracetamol is recommended despite limited procedure-specific evidence, based on previous recommendations (Joshi 2015).