title: Multimodal analgesic approach incorporating paravertebral blocks for open radical retropubic prostatectomy: a randomized double-blind placebo-controlled study.
abstract: BACKGROUND
  Perioperative pain management influences both the quality as well as the speed of recovery following surgery.
  
  
  METHODS
  This was a randomized double-blind placebo-controlled study designed to assess the effectiveness of a multimodal analgesic approach (MMA) vs patient-controlled analgesia (PCA) alone in patients undergoing open prostatectomy. Prior to surgery, paravertebral blocks (PVBs) were performed with either 0.5% ropivacaine in the MMA group or saline in the PCA group. Patients in the MMA group also received celecoxib (400 mg po prior to surgery and 200 mg po bid for seven days following surgery) and ketamine 10 mg iv. Following surgery, every patient had free access to morphine PCA. A pain numerical rating scale (NRS) at 24 hr was chosen as the primary endpoint. Secondary endpoints included morphine consumption at 24 hr and SF-36 (36-Item Short-Form Health Survey) scores from two weeks to 24 weeks following surgery.
  
  
  RESULTS
  The primary endpoint, average pain NRS at 24 hr, was 2.6 in the MMA group compared with 3.9 in the PCA group (difference = -1.6, 95% confidence interval [CI]: -2.3 to -0.4; P = 0.01). The average morphine consumption at 24 hr was 4.8 mg in the MMA group compared with 10.5 mg in the PCA group (difference = -5.7, 95% CI: -13.0 to 0.5; P = 0.01). Higher SF-36 scores at two, four, eight, and 12 weeks were observed in the MMA group compared with the PCA group, but no statistically significant (P < 0.05) between-group difference was found after Bonferroni correction of comparisons conducted repeatedly over time. Postoperative adverse effects included low episodes of postoperative nausea and vomiting, bladder spasms, constipation, and pruritus.
  
  
  CONCLUSIONS
  This study demonstrates that PVBs combined with celecoxib and ketamine provide better immediate postoperative pain control and facilitate earlier functional recovery in patients undergoing an open radical prostatectomy when compared with PCA alone.
authors.affiliation: Department of Anesthesiology, UPMC Shadyside Hospital, University of Pittsburgh Medical Center, Posner Pain Center, 532 South Aiken Avenue, Suite 407, Pittsburgh, PA, USA. chelje@anes.upmc.edu
authors.forename: Jacques E
authors.initials: JE
authors.lastname: Chelly
authors.forename: Taras
authors.initials: T
authors.lastname: Ploskanych
authors.forename: Feng
authors.initials: F
authors.lastname: Dai
authors.forename: Joel B
authors.initials: JB
authors.lastname: Nelson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016058:Analgesia, Patient-Controlled; D000700:Analgesics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000068579:Celecoxib; D004311:Double-Blind Method; D006801:Humans; D007649:Ketamine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects; D010149:Postoperative Pain / Q000517:prevention & control*; D011468:Prostatectomy; D011720:Pyrazoles / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D013449:Sulfonamides / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000700:Analgesics; D011720:Pyrazoles; D013449:Sulfonamides; D007649:Ketamine; D000068579:Celecoxib