title: Minimizing pain medication use and its associated costs following robotic surgery.
abstract: BACKGROUND
  Minimally invasive surgery (MIS) has been associated with diminished postoperative pain and analgesia requirements. The objective of the current study was to evaluate the use of analgesia in the post-operative period following robotic surgery for endometrial cancer.
  
  
  METHODS
  All consecutive patients who underwent robotic surgery for the treatment of endometrial cancer were included in this study. The timing, dose, and type of analgesics administered postoperatively were recorded from patients' electronic medical record. Data was compared to a matched historical cohort of patients who underwent laparotomy before the introduction of the robotic program.
  
  
  RESULTS
  Only eight patients (2.4%, 5 during the first 25 cases and 3 following mini-laparotomy) received patient-controlled analgesia (PCA) following robotic surgery. Most patients' pain was alleviated by over-the-counter analgesics (acetaminophen, non-steroidal anti-inflammatories). In comparison to laparotomy, patients who underwent robotic surgery required significantly less opioids (71mg vs. 12mg IV morphine, p<0.0001) and non-opioids (4810mg vs. 2151mg acetaminophen, 1892 vs. 377mg ibuprofen, and 1470mg vs. 393mg naproxen; all p<0.0001).
  
  
  CONCLUSIONS
  Patients require less analgesics (opioids and non-opioids) following robotic surgery in comparison to conventional laparotomy, including the elderly and the obese. The diminished pain medication use is associated with some cost savings.
authors.affiliation: Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Jeremie
authors.initials: J
authors.lastname: Abitbol
authors.affiliation: Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Cohn
authors.affiliation: Pain Management Division of Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Sandra
authors.initials: S
authors.lastname: Hunter
authors.affiliation: Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Rombaldi
authors.affiliation: Pharmacy Department, Lady Davis Institute of Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Eva
authors.initials: E
authors.lastname: Cohen
authors.affiliation: Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Roy
authors.initials: R
authors.lastname: Kessous
authors.affiliation: Pharmacy Department, Lady Davis Institute of Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Nick
authors.initials: N
authors.lastname: Large
authors.affiliation: Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Ari
authors.initials: A
authors.lastname: Reiss
authors.affiliation: Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Susie
authors.initials: S
authors.lastname: Lau
authors.affiliation: Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Shannon
authors.initials: S
authors.lastname: Salvador
authors.affiliation: Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada. Electronic address: walter.gotlieb@mcgill.ca.
authors.forename: Walter H
authors.initials: WH
authors.lastname: Gotlieb
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage; D000368:Aged; D016058:Analgesia, Patient-Controlled / Q000191:economics; D000700:Analgesics / Q000008:administration & dosage* / Q000191:economics; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D016527:Drug Costs; D057286:Electronic Health Records; D016889:Endometrial Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D007052:Ibuprofen / Q000008:administration & dosage; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects; D009020:Morphine / Q000008:administration & dosage; D009288:Naproxen / Q000008:administration & dosage; D010149:Postoperative Pain / Q000188:drug therapy*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects*
chemical_list: D000700:Analgesics; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000082:Acetaminophen; D009288:Naproxen; D009020:Morphine; D007052:Ibuprofen
keywords: Analgesics; Costs; Pain; Robotic surgery