title: Initial experience with ketamine-based analgesia in patients undergoing robotic radical cystectomy and diversion.
abstract: BACKGROUND
  We instituted a ketamine-predominant analgesic regimen in the peri- and postoperative periods to limit the effects of narcotic analgesia on bowel function in patients undergoing radical cystectomy. The primary end points of interest were time to return of bowel function, time to discharge, and efficacy of the analgesic regimen.
  
  
  METHODS
  We performed a retrospective chart review of patients undergoing robotic-assisted laparoscopic cystectomy (RARC) with urinary diversion by a single surgeon at our institution from January 1, 2011 to June 30, 2012. Patients receiving the opioid-minimizing ketamine protocol were compared to a cohort of patients undergoing RARC with an opioid-predominant analgesic regimen.
  
  
  RESULTS
  In total, 15 patients (Group A) were included in the ketamine-predominant regimen and 25 patients (Group B) in the opioid-predominant control group. Three patients (19%) in Group A discontinued the protocol due to ketamine side effects. The mean time to bowel movement and length of stay in Group A versus Group B was 3 versus 6 days (p < 0.001), and 4 versus 8 days, respectively (p < 0.001). Group A patients received an average of 13.0 mg of morphine versus 97.5 mg in Group B (p < 0.001).
  
  
  CONCLUSIONS
  Patients who received our ketamine pain control regimen had a shorter time to return of bowel function and length of hospitalization after RARC. Our study has its limitations as a retrospective, single surgeon, single institution study and the non-randomization of patients. Notwithstanding these limitations, this study was not designed to show inferiority of one approach, but instead to show that our protocol is safe and efficacious, warranting further study in a prospective fashion.
authors.affiliation: Department of Urology, Medical College of Wisconsin, Milwaukee, WI;
authors.forename: Kenneth
authors.initials: K
authors.lastname: Jacobsohn
authors.affiliation: Children's National Medical Center, Washington, D.C.;
authors.forename: Tanya D
authors.initials: TD
authors.lastname: Davis
authors.affiliation: Department of Urology, Medical College of Wisconsin, Milwaukee, WI;
authors.forename: Ahmad M
authors.initials: AM
authors.lastname: El-Arabi
authors.affiliation: Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Tlachac
authors.affiliation: Department of Urology, Medical College of Wisconsin, Milwaukee, WI;
authors.forename: Peter
authors.initials: P
authors.lastname: Langenstroer
authors.affiliation: Department of Urology, Medical College of Wisconsin, Milwaukee, WI;
authors.forename: R Corey
authors.initials: RC
authors.lastname: O'Connor
authors.affiliation: Department of Urology, Medical College of Wisconsin, Milwaukee, WI;
authors.forename: Michael L
authors.initials: ML
authors.lastname: Guralnick
authors.affiliation: Department of Urology, Medical College of Wisconsin, Milwaukee, WI;
authors.forename: William A
authors.initials: WA
authors.lastname: See
authors.affiliation: Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Robert
authors.initials: R
authors.lastname: Schlosser