PROSPECT provides clinicians with supporting arguments for and against the use of various interventions in postoperative pain based on published evidence and expert opinion. Clinicians must make judgements based upon the clinical circumstances and local regulations. At all times, local prescribing information for the drugs referred to must be consulted.
Pain remains an important issue after radical prostatectomy, resulting in discomfort and sometimes prolonged hospital stay (Tan 2015). Adequate pain management is needed to optimise postoperative recovery (Joshi 2014).
Patients undergoing open radical prostatectomy typically experience moderate dynamic pain in the immediate postoperative days (d’Alonzo 2009). Robot-assisted and laparoscopic surgery is less painful than open prostatectomy, although trocar ports may be a source of parietal pain after robot surgery (d’Alonzo 2009; Woldu 2014). Postoperative analgesic protocols should reflect these different pain profiles and the specific evidence identified in the literature.
The aim of this review was to update the recommendations for optimal pain management after open and laparoscopic or robotic prostatectomy.
PROSPECT recommendations for radical prostatectomy, based on a systematic literature review, were initially published in 2015 (Joshi 2015), which updated the literature and recommendations made on the website in 2012 (Archive: Radical prostatectomy 2012). However, several new analgesic regimens, particularly regional analgesic techniques, have since been introduced and robot surgery has been developed on a larger scale, so an update to the systematic review was warranted.
The recommendations for the current review have been built on those of the previous review, supported by additional information from the more recent studies.
The unique PROSPECT methodology is available at https://esraeurope.org/prospect-methodology/.
COX, cyclooxygenase; IV, intravenous; NSAIDs, non-steroidal anti-inflammatory drugs; TAP, transversus abdominis plane.
COX, cyclooxygenase; NSAIDs, non-steroidal anti-inflammatory drugs.
Analgesic interventions that are not recommended for pain management in patients undergoing radical prostatectomy.
TAP, transversus abdominis plane.
COX, cyclooxygenase; NSAID, non-steroidal anti-inflammatory drug; TAP, transversus abdominis plane.