ERAS Society 2019: Prophylaxis and Pain Management in Urologic Surgery
Non-narcotic analgesia is the cornerstone of modern urologic surgery and ERAS initiatives. He presented an interesting scenario where his institution withheld the use of alvimopan and was strongly encouraged to implement a complete non-opioid program. Perioperatively this consisted of acetaminophen, gabapentin, and celecoxib. General anesthesia consisted of ketamine infusion with propofol only eliminating any gases used in anesthesia. During surgery, propofol, ketamine, and dexmedetomidine was administered. At the time of surgery, a regional block was performed prior to incision, consisting of a quadratus lumborum block or transversus abdominis plane (TAP)/rectus sheath block. Postoperatively, acetaminophen, gabapentin, and ketorolac was used for pain control. They observed improved pain control and significantly decreased need for any narcotic analgesics. These findings encourage the elimination of narcotics in pain management among patients undergoing urologic surgery with durable results noted in this study and others. Further efforts are needed to reinforce this practice worldwide.
Presented by: John Sfakianos, MD, Mount Sinai Queens St. Luke's, New York, New York, United States
Written by: Stephen B. Williams, MD, Associate Professor, Division of Urology, The University of Texas Medical Branch, Galveston, Texas at the 7th ERAS World Congress, Liverpool, UK, 1-3 May 2019.