Postoperative pain and neuromuscular complications associated with patient positioning after robotic assisted laparoscopic radical prostatectomy: a retrospective non-placebo and non-randomized study.
OBJECTIVE
To evaluate postoperative pain and neuromuscular complications associated with positioning after robotic assisted laparoscopic radical prostatectomy (RALP).


METHODS
Between September 2010 and June 2014, 534 patients who underwent RALP were evaluated. Patients were positioned in operating theater by operating room staff, and two independent urologists noted postoperative follow-up. Patient's demographic data, postoperative complications associated with positioning, pain score according to visual analogue scale, and hospital stay were recorded. Statistical analyses were performed and p < 0.05 was considered significant.


RESULTS
Postoperative pain and neuromuscular complications were observed in 54 (10.1 %) and 27 (5 %) patients, respectively. We found ASA, BMI, and comorbidities were significantly associated with postoperative pain levels in univariate analyses (p = 0.01, p = 0.013, and p = 0.01, respectively). Additionally, ASA, previous operations, and comorbidities were significantly associated with postoperative neuromuscular complications (p = 0.04, p = 0.01, and p = 0.02, respectively). According to statistical analyses, BMI < 30 and presence of an implant were significantly associated with postoperative pain in multivariate logistic regression analyses (p = 0.010 and p = 0.033, respectively). Additionally, having comorbidities was significantly associated with postoperative neuromuscular complications in multivariate analyses (p = 0.04).


CONCLUSIONS
Patients with previous operations, comorbidities, and high ASA score are at risk of neuromuscular complications during RALP. Lower BMI and having an implant also lead to higher postoperative pain. Operating room staff and anaesthesia team should be very careful with patients undergoing RALP in steep Trendelenburg and low-lithotomy position.
School of Nursing, Gulhane Military Medical Academy, Ankara, Turkey.
Elif
E
Gezginci
Department of Urology, Avrasya Hospital, Istanbul, Turkey.
Orkunt
O
Ozkaptan
Department of Urology, Gulhane Military Medical Academy, Ankara, Turkey.
Serdar
S
Yalcin
Department of Urology, SLK-Kliniken, University of Heidelberg, Am Gesundbrunnen 20-26, 74078, Heilbronn, Germany.
Yigit
Y
Akin
Department of Urology, SLK-Kliniken, University of Heidelberg, Am Gesundbrunnen 20-26, 74078, Heilbronn, Germany.
Jens
J
Rassweiler
Department of Urology, SLK-Kliniken, University of Heidelberg, Am Gesundbrunnen 20-26, 74078, Heilbronn, Germany. asgozen@gmail.com.
Ali Serdar
AS
Gozen
D000368:Aged; D015992:Body Mass Index; D015897:Comorbidity; D018475:Head-Down Tilt / Q000009:adverse effects; D006304:Health Status; D006801:Humans; D006987:Hypesthesia / Q000209:etiology; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000209:etiology; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology*; D010292:Paresthesia / Q000209:etiology; D056888:Patient Positioning / Q000009:adverse effects*; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods; D011471:Prostatic Neoplasms / Q000601:surgery*; D019736:Prostheses and Implants; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects*
Complications; Ergonomics; Pain; Prostate cancer; Robotics