Impact of analgesic techniques on early quality of recovery after prostatectomy: A 3‐arm, randomized trial

Abstract

Background Prostatectomy is associated with relevant acute postoperative pain. Optimal analgesic techniques to minimize pain and enhance recovery are still under investigation. We aimed to compare the effect of three different analgesic techniques on quality of recovery. Methods This investigator‐initiated, prospective, randomized, three‐arm, parallel‐group, active‐controlled, interventional superiority trial was performed in a Swiss teaching hospital from 2018 to 2021. Consecutive patients undergoing open or robotic‐assisted radical prostatectomy were randomized to spinal anaesthesia (SSS, bupivacaine 0.5% + fentanyl), bilateral transversus abdominis plane block (TAP, ropivacaine 0.375% + clonidine) or systemic administration of lidocaine (SA, lidocaine 1%) in addition to general anaesthesia. Primary outcome was quality of recovery 15 (QoR‐15) score on postoperative day one compared to baseline. Secondary outcomes were QoR‐15 at discharge, postoperative nausea and vomiting, pain scores, return of gastrointestinal function and use of rescue analgesia. Results From 133 patients, 40 received spinal anaesthesia, 45 TAP block and 48 systemic analgesia. QoR‐15 scores did not differ on day 1 (p = 0.301) or at discharge (p = 0.309) when compared to baseline. QoR‐15 changes were similar in all groups. At discharge, median QoR‐15 scores were considered as good (>122) in all groups: SSS 134 [IQR 128–138]; TAP 129 [IQR 122–136] and SA 128 [IQR 123–136]. There were no significant differences in the other secondary outcomes. Conclusions Quality of recovery on postoperative day one compared to baseline did not differ if spinal anaesthesia, TAP block or systemic administration of lidocaine was added to general anaesthesia. Significance Optimal analgesic techniques to enhance recovery after prostatectomy are still under investigation. In this 3‐arm randomized controlled trial, addition of spinal anaesthesia or transversus abdominis plane block to general anaesthesia did not improve quality of recovery after radical prostatectomy compared to less invasive intravenous lidocaine infusion (standard of care/control group). Quality of recovery at the time of discharge was considered as good in all three groups.

The Effect of Epidural Analgesia on Quality of Recovery (QoR) after Radical Prostatectomy

“…There is no literature regarding ORP and QoR-40. A recent work by Beilstein et al [ 28 ] evaluated analgesia after radical prostatectomy with QoR-15. They evaluated the effect of three different analgesic concepts: spinal single shot, TAP block, and the systemic administration of lidocaine.…”

Authors' reply to the comment by Shan et al.

“…Dear Editor, We would like to thank Dr. Jjang et al for raising these questions regarding our recently published work and would like to provide clarification (Beilstein et al, 2022).…”

“…First question (primary endpoint): Assuming that baseline QoR-15 values in all groups are comparable (which in fact was the case, see table 2 of the original article), it is from minor relevance if one compares absolute values or differences to baseline (Beilstein et al, 2022). In fact, the latter has the advantage of eliminating variation in baseline values.…”

Comment on ‘Impact of analgesic techniques on early quality of recovery after prostatectomy: A 3‐arm, randomized trial’ by Beilstein and colleagues

“…In an investigator-initiated, prospective, randomized, threearm, parallel-group, active-controlled, interventional superiority trial that included 133 patients undergoing open or robotic-assisted radical prostatectomy, Beilstein et al (2022) compared the effects of adding spinal anaesthesia, transversus abdominis plane block and intravenous lidocaine to general anaesthesia on quality of early post-operative recovery assessed by the quality of recovery-15 (QoR-15) score. They showed that the addition of three different analgesic techniques to general anaesthesia did not improve the quality of early post-operative recovery.…”