ABSTRACT
Purpose
Opioid free anesthesia (OFA) is associated with decreased risk of PONV and need for
rescue analgesia, making it ideal for patients anticipating same-day discharge. The
purpose of this project was to describe the perioperative care and short-term outcomes
for patients undergoing robotic-assisted radical prostatectomy (RARP) under OFA at
an ambulatory surgical center (ASC).
Design
A retrospective descriptive design was used to examine the perioperative care and
short-term outcomes of patients undergoing RARP under OFA at an ASC.
Methods
The records of all sequential patients undergoing RARP over an 18-month period were
reviewed. Data collected included patient comorbidities, surgical procedures, medications
administered, verbal numeric rating scale (VNRS) for pain scores, times to oral intake,
ambulation, and discharge, patient disposition, and unplanned return to the ER or
hospital within 30 days.
Findings
Data were extracted from 54 sequential records. Median VNRS scores were zero throughout
PACU stay. Fifty-three patients (98.1%) were successfully discharged home, with an
average postoperative stay of 250.8 (SD 35.0) minutes. There were no complaints of
post-discharge nausea and vomiting or intractable pain at 72 hours after surgery.
One patient was transferred to the hospital and two patients returned to the emergency
room within 30 days.
Conclusions
Although generalizability is limited, these results suggest that carefully selected
patients can be discharged home after RARP under a balanced OFA technique. Innovative
practices are needed to address the current backlog of patients needing non-emergent
surgery. Discharge home avoids the increase in resource consumption and infection
risk associated with hospital admission.
Keywords
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References
- Outpatient prostatectomy: too much too soon or just what the patient ordered.Urology. 2010; 75: 421-424https://doi.org/10.1016/j.urology.2009.08.085
- Outpatient robot-assisted radical prostatectomy: Are patients ready for same-day discharge?.J Endourol. 2020; 34: 450-455https://doi.org/10.1089/end.2019.0796
- Outpatient robotic radical prostatectomy: matched-pair comparison with inpatient surgery.J Endourol. 2016; 30 (S52-6)https://doi.org/10.1089/end.2016.0135
- Safety and feasibility of outpatient robot-assisted radical prostatectomy.J Robot Surg. 2019; 13: 261-265https://doi.org/10.1007/s11701-018-0848-8
- Outpatient robot-assisted radical prostatectomy: a feasibility study.Urology. 2019; 128: 16-22https://doi.org/10.1016/j.urology.2019.01.050
- Feasibility of dexmedetomidine as sole analgesic agent during robotic urological surgery: a pilot study.J Anaesthesiol Clin Pharmacol. 2017; 33: 187-192https://doi.org/10.4103/0970-9185.209753
- Anaesthetic factors affecting outcome after bariatric surgery: a retrospective levelled regression analysis.Obes Surg. 2019; 29: 1841-1850https://doi.org/10.1007/s11695-019-03763-1
- Different protocols used today to achieve total opioid-free general anesthesia without locoregional blocks.Best Pract Res Clin Anaesthesiol. 2017; 31: 533-545https://doi.org/10.1016/j.bpa.2017.11.003
- Safety and feasibility of same-day discharge laparoscopic radical prostatectomy: a systematic review.World J Urol. 2022; https://doi.org/10.1007/s00345-022-03944-1
- Balanced opioid-free anesthesia with dexmedetomidine versus balanced anesthesia with remifentanil for major or intermediate noncardiac surgery.Anesthesiology. 2021; 134: 541-551https://doi.org/10.1097/ALN.0000000000003725
- Opioid-free total intravenous anaesthesia reduces postoperative nausea and vomiting in bariatric surgery beyond triple prophylaxis.Br J Anaesth. 2014; 112: 906-911https://doi.org/10.1093/bja/aet551
- The consequences of delaying elective surgery: surgical perspective.Ann Surg. 2020; 272: e79-e80https://doi.org/10.1097/SLA.0000000000003998
- Breast surgery in the time of global pandemic: benefits of same-day surgery for breast cancer patients undergoing mastectomy with immediate reconstruction during COVID-19.Plast Reconstr Surg. 2020; 146: 522e-523ehttps://doi.org/10.1097/PRS.0000000000007269
Article info
Publication history
Published online: January 02, 2023
Publication stage
In Press Corrected ProofFootnotes
Conflict of Interest: None to report.
Identification
Copyright
© 2022 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.
