title: Pain and analgesic use after robot-assisted radical prostatectomy.
abstract: OBJECTIVE
  While robot-assisted radical prostatectomy (RARP) is associated with shortened convalescence and decreased blood loss over open prostatectomy, little objective data is available regarding postoperative pain/discomfort and use of analgesic medications after RARP. We sought to examine these parameters in a contemporary cohort.
  
  
  METHODS
  From 2011 to 2013, patients undergoing RARP were prospectively enrolled in a study to examine various pain parameters and carefully monitor opiate and other analgesic medication use while the patient recovered in the hospital. After discharge, the patients were asked to fill out a daily questionnaire regarding their pain parameters and self-report opiate usage. All questionnaires were based on the Wong-Baker FACES pain rating scale (0-10). Opiate dosages were converted to the approximate oral morphine sulfate equivalent dose (MSE).
  
  
  RESULTS
  A total of 60 patients, mean age 61 years, were enrolled in the study, underwent RARP, and completed follow-up questionnaires. None had a history of chronic narcotic use. Intraoperative opiate use was 94.1 mg MSE. There were 73.3% who received immediate postoperative ketorolac. After RARP, the main source of pain/discomfort was abdominal/incisional, followed by urethral catheter-related, penile, and bladder spasm-related discomfort. Abdominal pain was generally moderate for most patients and decreased significantly after about 4 days. Penile and urethral catheter-related discomfort was mild throughout the study period. Opiate analgesic medication use quickly decreased as the subjective pain scores improved.
  
  
  CONCLUSIONS
  After RARP, most patients experience mild/moderate abdominal discomfort, which improves steadily over several days. There is also a quick decline in the average opiate pain medication use that corresponds to the subjective improvement in pain symptoms. This information is useful for clinicians counseling patients on the pain associated with RARP and can serve as a reference to compare the convalescence associated with the other options for treatment of patients with localized prostate cancer.
authors.affiliation: Department of Urology, Columbia University Medical Center , New York, New York.
authors.forename: Solomon L
authors.initials: SL
authors.lastname: Woldu
authors.forename: Aaron C
authors.initials: AC
authors.lastname: Weinberg
authors.forename: Ari
authors.initials: A
authors.lastname: Bergman
authors.forename: Edan Y
authors.initials: EY
authors.lastname: Shapiro
authors.forename: Ruslan
authors.initials: R
authors.lastname: Korets
authors.forename: Piruz
authors.initials: P
authors.lastname: Motamedinia
authors.forename: Ketan K
authors.initials: KK
authors.lastname: Badani
mesh_terms: D015746:Abdominal Pain / Q000188:drug therapy / Q000209:etiology; D000082:Acetaminophen / Q000008:administration & dosage; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D002404:Catheterization; D003061:Codeine / Q000008:administration & dosage; D004338:Drug Combinations; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D010147:Pain Measurement / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D011446:Prospective Studies; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000209:etiology / Q000601:surgery; D018570:Risk Assessment; D012371:Robotics / Q000379:methods*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014546:Urinary Catheterization / Q000009:adverse effects
chemical_list: D000701:Analgesics, Opioid; D004338:Drug Combinations; C526278:acetaminophen, codeine drug combination; D000082:Acetaminophen; D003061:Codeine