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The objective was to study the safety and efficacy of a personalized opioid-sparing pain relief protocol in the context of enhanced rehabilitation after advanced robot-assisted pelvic surgery. Materials and methods . The prospective study included 19 patients who underwent surgery under combined thoracic epidural anesthesia/analgesia: general anesthesia was administered with propofol or sevoflurane/desflurane with ketamine + 6–8 ml/hour of 0.25% ropivacaine, in the postoperative period 0.125% bupivacaine was administered at a rate of 8–15 ml/hour. In the comparison group ( n = 21), opioids were used as a component of general anesthesia and multimodal analgesia. Intra- and postoperative opioid consumption, pain severity, opioid-related side effects, and timing of postoperative rehabilitation were evaluated. Results . In the study group, the median milligram equivalents of morphine were significantly lower than in the control group (103 versus 148 and 91 versus 404, respectively; p = 0.001 for both comparisons). The values of the numerical pain scale did not differ significantly between the groups. Side effects were significantly lower in the treatment group (26% vs. 62%; p = 0.026). There were significant differences in the timing of intestinal function recovery, initiation of regular diet and transfer from the recovery room in favor of opioid-sparing pain relief ( p = 0.037; p = 0.046; and p = 0.023; respectively). Conclusions . The use of a personalized opioid-sparing pain relief protocol in the context of enhanced rehabilitation of patients underwent the advanced robot-assisted pelvic surgery helped to reduce opioid consumption, side effects, and postoperative rehabilitation without affecting the severity of pain.
Lifanova et al. (Wed,) studied this question.