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| The effect of adjunct caudal block on postoperative analgesia in robot-assisted laparoscopic radical prostatectomy: A prospective randomized controlled, single blinded pilot study in a tertiary centre |
Chen Kennetha,Sim Allena,Kan Alex Fordb( )
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a Department of Urology, Singapore General Hospital, Singapore
b Department of Anaesthesiology, Singapore General Hospital, Singapore |
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Abstract Objective Caudal block provides satisfactory postoperative pain relief in lower abdominal operations. This pilot study explores its safety and effect on postoperative pain control in patients who underwent robot-assisted laparoscopic radical prostatectomy (RARP). Methods From 2013 to 2014, 40 consecutive patients were randomized into two groups — one received caudal block using ropivacaine immediately after operation, the other received standard analgesia. Primary outcome measure was pain score based on 11-point Likert scale (0-10) recorded at recovery room, and at 6, 12, 24, 48, and 72 h after operation. All analgesic requirements, opioid-related adverse events and time to passage of flatus were examined. Results Mean age of the two groups was similar (60.4 vs. 62.3 years, p = 0.33), as was American Society of Anaesthesiologists (ASA) class, body mass index (BMI) and operation times. No significant difference in median pain scores was reported in recovery room (2 vs. 3, p = 0.34), and at 6 h (2 vs. 2, p = 0.94), 12 h (0 vs. 0, p = 0.62), 24 h (1 vs. 0, p = 0.58), 48 h (1 vs. 0, p = 0.36) and 72 h (0 vs. 0, p = 0.78) postoperatively between control and caudal block groups, respectively. There was a higher mean opioid usage in the caudal block group which was not statistically significant. Although this was statistically insignificant while no significant difference in mean paracetamol usage was observed postoperatively. Median time to passage of flatus was similar (2.0 vs. 2.0 days, p = 0.97). There was one case of superficial wound infection and no opioid-related adverse events observed. Hospital stay was similar in both groups (2.5 vs. 2.5 days, p = 0.96). Conclusion Although a safe modality, caudal block in post RARP patients does not seem to improve pain control nor reduce analgesia requirements.
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Received: 24 August 2016
Published: 09 June 2018
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Flow diagram of patient recruitment and allocation. RARP, robot-assisted laparoscopic radical prostatectomy.
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| Control (n = 20) | Caudal (n = 20) | p-value | | Age (year)a | 62.3 ± 5.5 | 60.4 ± 6.7 | 0.33 | | Race | | Chinese | 16 | 17 | | | Malay | 0 | 1 | | | Indian | 2 | 1 | | | Others | 2 | 1 | | | Height (cm)a | 168.7 ± 5.4 | 170.0 ± 7.1 | 0.52 | | Weight (kg)a | 70.3 ± 10.5 | 70.5 ± 9.7 | 0.95 | | BMI (kg/m2)a | 24.3 ± 5.2 | 24.7 ± 3.7 | 0.72 | | ASA class, n (%) | | 1 | 1 (5) | 4 (20) | | | 2 | 16 (80) | 16 (80) | | | 3 | 3 (15) | 0 (0) | | | Operation time (min)a | 243.0 ± 50.8 | 245.0 ± 55.8 | 0.90 |
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| Time point | Pain score, median (range) | p-value | | Control (n = 20) | Caudal (n = 20) | | Recovery | 2 (0-8) | 3 (0-8) | 0.34 | | 6 h postoperation | 2 (0-5) | 2 (0-4) | 0.94 | | 12 h postoperation | 0 (0-4) | 0 (0-5) | 0.62 | | 24 h postoperation | 1 (0-8) | 0 (0-5) | 0.58 | | 48 h postoperation | 1 (0-4) | 0 (0-6) | 0.36 | | 72 h postoperation | 0 (0-3) | 0 (0-3) | 0.78 |
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| Time point | Opioid usage (mg), mean ± SE | p-value | | Control (n = 20) | Caudal (n = 20) | | Recovery | 2.8 ± 1.2 | 4.3 ± 1.3 | 0.41 | | 24 h postoperation | 0 | 2.3 ± 1.4 | 0.11 | | 48 h postoperation | 0.3 ± 0.3 | 1.3 ± 1.0 | 0.35 | | 72 h postoperation | 0 | 0.3 ± 0.3 | 0.32 |
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| Time point | Paracetamol usage (mg), mean ± SE | p-value | | Control | Caudal | | Recovery | 250.0 ± 99.3 | 300.0 ± 105.1 | 0.76 | | 24 h postoperation | 1950.0 ± 256.2 | 2150.0 ± 232.6 | 0.57 | | 48 h postoperation | 1927.5 ± 271.4 | 1850.0 ± 334.6 | 0.86 | | 72 h postoperation | 527.5 ± 233.6 | 650.0 ± 181.7 | 0.68 |
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