title: Evaluation of analgesic requirements and postoperative recovery after radical retropubic prostatectomy using long-acting spinal anesthesia.
abstract: OBJECTIVE
  To analyze the postoperative pain, analgesic requirements, and convalescence of patients undergoing radical retropubic prostatectomy (RRP) under spinal anesthesia using long-acting morphine sulfate as preemptive analgesia.
  
  
  METHODS
  A total of 103 consecutive men underwent RRP by a single surgeon. The time to tolerate oral fluids, time to unassisted ambulation, postoperative pain levels (visual analog pain score of 0 to 10), and analgesic requirements expressed in morphine equivalents were evaluated. Baseline patient characteristics and intraoperative factors (operating room time, blood loss) were also evaluated.
  
  
  RESULTS
  The mean time to tolerate oral fluids and unassisted ambulation was 11.3 +/- 7.6 hours and 20 +/- 6 hours, respectively. The mean narcotic requirements were 7.4 +/- 6.1 morphine equivalents before discharge and 28.5 +/- 25.9 morphine equivalents in the first week after discharge. The mean visual analog pain score was 4.5 +/- 2.1 at discharge and fell significantly to 1.5 +/- 1.0 by the time of Foley catheter removal on postoperative day 7 or 8. The analgesic requirements after discharge correlated with the pain score at discharge (P = 0.016). The mean time to resumption of normal preoperative activities was 19.4 +/- 9.4 days. Two patients developed postspinal anesthesia headache. No other complications attributable to the anesthetic occurred.
  
  
  CONCLUSIONS
  RRP may be performed through a small modified Pfannenstiel incision under spinal anesthesia containing long-acting morphine with little postoperative pain, low narcotic requirements, and a short convalescence. A prospective, randomized study is needed to compare the early postoperative outcomes of RRP performed using general versus spinal anesthesia.
authors.affiliation: Department of Urology, University of Miami School of Medicine, Miami, Florida 33101, USA.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Sved
authors.forename: Alan M
authors.initials: AM
authors.lastname: Nieder
authors.forename: Murugesan
authors.initials: M
authors.lastname: Manoharan
authors.forename: Pablo
authors.initials: P
authors.lastname: Gomez
authors.forename: David S
authors.initials: DS
authors.lastname: Meinbach
authors.forename: Sandy S
authors.initials: SS
authors.lastname: Kim
authors.forename: Mark S
authors.initials: MS
authors.lastname: Soloway
mesh_terms: D000698:Analgesia; D000775:Anesthesia, Spinal / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects*; D013997:Time Factors