Abstract
Background
Veterans have disproportionate risk of opioid misuse and abuse compared to the civilian
population. Managing acute postoperative pain without opioids is of the utmost importance
for the Veteran patient population. This pilot study evaluates a novel multimodal
opioid-free pain control regimen by assessing postoperative pain in Veterans undergoing
robotic-assisted radical prostatectomy (RARP).
Methods
Prospective data was collected from patients undergoing RARP at a Department of Veterans
Affairs Medical Center. Patients in the opioid-cohort received tramadol, hydrocodone-acetaminophen,
or oxycodone-acetaminophen postoperatively. The opioid-free novel multimodal approach
consisted of 100 mg gabapentin TID, 15 mg ketorolac Q6 hours, and 1 mg scheduled IV
acetaminophen Q6 hours. Pain scores were collected using a visual analogue pain scale
on postoperative days 0 and 1.
Results
Data was collected from 57 patients, 33 treated with opioids and 24 with the opioid-free
pathway. There were no significant differences in demographics (P > .05) between cohorts. No significant differences were observed for preoperative
and intraoperative variables (P > .05). Average postoperative day 0 pain scores for opioid-free (2.2 ± 3.1) and opioid
treatments (3.1 ± 3.1) were not statistically different (P = .1321). Postoperative day 1 differences of average pain scores for opioid-free
(0.9 ± 1.9) and opioid (1.6 ± 3.1) treatments were not statistically significant (P = .1647).
Conclusions
The novel multimodal opioid-free treatment in this study may be effectively utilized
for postoperative pain during hospital recovery of Veterans undergoing RARP. Future
directions include a randomized control clinical trial in the general population.
Keywords
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Article info
Publication history
Published online: May 10, 2022
Accepted:
May 2,
2022
Received in revised form:
May 2,
2022
Received:
October 15,
2021
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
