Does a perioperative belladonna and opium suppository improve postoperative pain following robotic assisted laparoscopic radical prostatectomy? Results of a single institution randomized study.
BACKGROUND
Robotic assisted laparoscopic radical prostatectomy (RALP) is a common treatment for localized prostate cancer. Despite a primary advantage of improved postoperative pain, patients undergoing RALP still experience discomfort. Belladonna, containing the muscarinic receptor antagonists atropine and scopolamine, in combination with opium as a rectal suppository (B & O) may improve post-RALP pain. This study evaluates whether a single preoperative B & O results in decreased postoperative patient-reported pain and analgesic requirements.


METHODS
Patients undergoing RALP at Virginia Mason Medical Center between November 2008 and July 2009 were offered the opportunity to enter a randomized, double-blind, placebo-controlled trial. Exclusion criteria included: glaucoma, bronchial asthma, convulsive disorders, chronic pain, chronic use of analgesics, or a history of alcohol or opioid dependency. Surgeons were blinded to suppository placement which was administered after induction of anesthesia. All patients underwent a standardized anesthesia regimen. Postoperative pain was assessed by a visual analog scale (VAS) and postoperative narcotic use was calculated in intravenous morphine equivalents.


RESULTS
Ninety-nine patients were included in the analysis. The B & O and control groups were not significantly different in terms of age, body mass index, operative time, nerve sparing status or prostatic volume. Postoperative pain was significantly improved during the first two postoperative hours in the B & O group. Similarly, 24-hour morphine consumption was significantly lower in patients who received a B & O. No adverse effects secondary to suppository placement were identified.


CONCLUSIONS
Preoperative administration of B & O suppository results in significantly decreased postoperative pain and 24-hour morphine consumption in patients undergoing RALP.
Virginia Mason Medical Center, Seattle, Washington 98111, USA.
Stephen
S
Lukasewycz
Matt
M
Holman
Paul
P
Kozlowski
Christopher R
CR
Porter
Erin
E
Odom
Chris
C
Bernards
Nancy
N
Neil
John M
JM
Corman
D000368:Aged; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000627:therapeutic use; D001532:Atropa belladonna; D001285:Atropine / Q000008:administration & dosage / Q000627:therapeutic use; D004311:Double-Blind Method; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D018727:Muscarinic Antagonists / Q000008:administration & dosage* / Q000627:therapeutic use; D010149:Postoperative Pain / Q000188:drug therapy* / Q000191:economics; D008517:Phytotherapy / Q000191:economics; D028321:Plant Preparations / Q000008:administration & dosage* / Q000627:therapeutic use; D011300:Preoperative Care / Q000191:economics / Q000379:methods*; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000601:surgery; D012371:Robotics; D012601:Scopolamine / Q000008:administration & dosage / Q000627:therapeutic use; D013488:Suppositories
D000701:Analgesics, Opioid; D018727:Muscarinic Antagonists; D028321:Plant Preparations; D013488:Suppositories; D009020:Morphine; D001285:Atropine; D012601:Scopolamine