Multimodal analgesia for radical prostatectomy provides better analgesia and shortens hospital stay

Abstract Study Objective To assess the clinical impact of paravertebral blocks (PVBs) on the immediate outcome of patients undergoing radical prostatectomy. Design Retrospective review. Setting Urology ward of a university medical center. Measurements Records of 100 consecutive patients who underwent a radical prostatectomy by the same surgeon were examined. In the first 50 patients (group 1), at surgical closure, the wound was infiltrated with 30 mL bupivacaine 0.25% and ketorolac 30 mg administered intravenously (IV). Postoperatively, patients received 15 mg ketorolac IV every 6 hours for 48 hours. Opioid (IV) patient-controlled analgesia was given overnight and thereafter, opioids were given orally as needed. The remaining 50 patients (group 2) received, in addition to the cited medication, a single preoperative oral dose of valdecoxib (40 mg) and preoperative bilateral PVBs at T10-T11-T12 using ropivacaine 0.5% (5 mL per level). Pain scores, opioid consumption, and hospital length of stay (LOS) were recorded. Main Results Addition of preoperative valdecoxib and bilateral PVBs was associated with significantly lower pain scores and opioid consumption. Hospital LOS was reduced from an average of 56 hours in group 1 to 47 hours in group 2. Conclusions Preoperative bilateral PVBs and a single dose of a COX-2 inhibitor may improve immediate outcome and shorten hospital LOS after radical retropubic prostatectomy.