title: Optimal pain management for radical prostatectomy surgery: what is the evidence?
abstract: BACKGROUND
  Increase in the diagnosis of prostate cancer has increased the incidence of radical prostatectomy. However, the literature assessing pain therapy for this procedure has not been systematically evaluated. Thus, optimal pain therapy for patients undergoing radical prostatectomy remains controversial.
  
  
  METHODS
  Medline, Embase, and Cochrane Central Register of Controlled Trials were searched for studies assessing the effects of analgesic and anesthetic interventions on pain after radical prostatectomy. All searches were conducted in October 2012 and updated in June 2015.
  
  
  RESULTS
  Most treatments studied improved pain relief and/or reduced opioid requirements. However, there were significant differences in the study designs and the variables evaluated, precluding quantitative analysis and consensus recommendations.
  
  
  CONCLUSIONS
  This systematic review reveals that there is a lack of evidence to develop an optimal pain management protocol in patients undergoing radical prostatectomy. Most studies assessed unimodal analgesic approaches rather than a multimodal technique. There is a need for more procedure-specific studies comparing pain and analgesic requirements for open and minimally invasive surgical procedures. Finally, while we wait for appropriate procedure specific evidence from publication of adequate studies assessing optimal pain management after radical prostatectomy, we propose a basic analgesic guideline.
authors.affiliation: Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical School, 5323 Harry Hines Blvd, Dallas, TX, 75390-9068, USA. girish.joshi@utsouthwestern.edu.
authors.forename: Grish P
authors.initials: GP
authors.lastname: Joshi
authors.affiliation: Institute for Research in Operative Medicine, Witten/Herdecke University, Cologne, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Jaschinski
authors.affiliation: Department d' Anesthesie Reanimation, Hôpital Tenon, Assistance Publique Hôpitaux de Paris Université Pierre & Marie Curie, Paris, France.
authors.forename: Francis
authors.initials: F
authors.lastname: Bonnet
authors.affiliation: Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Kehlet
mesh_terms: D000700:Analgesics / Q000008:administration & dosage; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000777:Anesthetics / Q000008:administration & dosage; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D000777:Anesthetics