An analysis of post-operative pain and narcotic use following robotic assisted laparoscopic prostatectomy for same day discharge

Robotic assisted laparoscopic prostatectomy (RALP) has become the primary surgical modality in the treatment of prostate cancer. Most patients are discharged on postoperative day one. Same-day discharge is emerging as a potential new standard. We sought to establish factors correlating with post-operative pain after RALP procedures to design a same-day discharge protocol. We retrospectively reviewed 150 of recently performed RALP procedures from March 2020 to January 2021. Patient demographics and intra-operative variables were compared to Numeric Rating Scale (NRS) pain scores and total morphine milliequivalents (MME) at 2 h, 8 h, and averaged over the patient’s admission post-operatively or first 48 h, whichever occurred first. We performed univariable and multivariable logistic regression to assess correlations with postoperative pain and narcotic use. NRS average > 3 or any MME given at 2 h postoperatively was significantly associated with continued post-operative pain averaged over admission (r_s = 0.32, 0.38, respectively; p < 0.001). MME given was also associated with longer operative time and negative related to body mass index. No other demographic data or intraoperative variables such as diabetes or pneumoperitoneum pressure were correlated with worsened post-operative pain scores > 3 or narcotic use. Local bupivacaine dose was also not associated with improved post-operative pain scores or narcotic use at 8 h (p = 0.98, 0.13). These findings suggest that patients with adequate postoperative pain control at 2 hours may be discharged same day from a pain control perspective. Further clinical evaluation regarding the role of local anesthetic use in RALPs is warranted.