Evaluation of a Novel Multimodal Opioid-Free Postoperative Pain Management Pathway Following Robotic-Assisted Radical Prostatectomy: A Pilot Series in the Veteran Population

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).

Hypothesis: Postoperative RARP pain treatment using a novel opioid-free multimodal pathway will demonstrate no significant differences in mean visual analogue pain scores on postoperative days 0 and 1 compared to traditional opioid treatment modalities.

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 100mg gabapentin TID, 15mg ketorolac Q6 hours, and 1mg 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 > 0.05) between cohorts. No significant differences were observed for preoperative and intraoperative variables (p > 0.05). 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 = 0.1321). 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 = 0.1647).

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.