Enhanced Recovery After Surgery (ERAS) protocols have been proven to optimize postoperative outcomes; however, misuse of opioid analgesics can still hinder postoperative recovery due to related side effects and potential complications.
To determine if the implementation of ERAS protocol in post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) patients could help with reducing postoperative pain and opioid use.
A case-control study of consecutive testicular cancer patients with indications for PCRLPND, who were offered Conventional Post-operative Management (CPM) or ERAS protocol. Outcomes of interest included Visual Analogue Scale (VAS)-assessed pain level at postoperative days 3, 7, and 30, and Morphine-Equivalent Doses (MEDs)/postoperative day. Intraoperative parameters and postoperative complications were recorded. Parametric and non-parametric tests were used for statistical analysis.
In total, 100 opioid-naïve PC-RPLND patients were studied. CPM and ERAS groups (36 and 64 patients, respectively) had similar demographic and baseline clinical characteristics). ERAS group patients had significantly lower blood loss (p = 0.005), blood transfusion rate (p < 0.001), and duration of the procedure (p < 0.001). Post-operative complications were comparable between groups. Nausea and bowel disorders were numerically but not statistically more frequent in the CPM group. ERAS patients had shorter mean hospital stay (5.3 ± 1.4 vs. 7.4 ± 1.6 days, p < 0.001), lower daily MEDs (4.73 ± 2.63 vs. 7.04 ± 2.29, p < 0.001), and lower VAS scores on post-operative day 7 (3.89 ± 1.07 vs. 4.67 ± 1.17, p = 0.001). Post-operative pain was similar between groups on post-operative days 3 and 30.
Systematic implementation of ERAS protocol after PC-RPLND improves pain management, optimizes patient recovery, and prevents over-prescription of opioid analgesics.
Current cancer drug targets. 2023 May 11 [Epub ahead of print]
Konstantinos Dimitropoulos, Louis L Pisters, Christos N Papandreou, Danai Daliani, Anastasios Karatzas, Argiro Petsiti, Vassilios Tassoudis, Eleni Arnaoutoglou, Panagiotis J Vlachostergios, Vassilios Tzortzis
Department of Urology, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, Scotland, United Kingdom., Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA., Department of Medical Oncology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece., Department of Medical Oncology, Euroclinic, Athens, Greece., Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, Larissa, Greece., Department of Anaesthesiology, University Hospital of Larissa, Larissa, Greece., Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY, USA., University Hospital of Larissa Department of Urology Larissa Greece.