Post-Operative Management for Robotic Simple Prostatectomy
For optimal post-operative management of robotic simple prostatectomy, implement a multimodal pain management approach with scheduled intravenous acetaminophen as the foundation, supplemented by NSAIDs when appropriate, and opioids only as rescue medication. 1
Pain Management
First-Line Approach
- Administer intravenous acetaminophen on a fixed schedule (around-the-clock) at 1000mg every 6 hours starting immediately post-operation and continuing until postoperative day 2 1
- This approach significantly reduces pain scores and the need for rescue analgesia during the critical first 48 hours post-surgery 1
Adjunctive Medications
- Add NSAIDs such as ketorolac (15-30mg IV) for additional analgesia, but use with caution in patients with bleeding risk 2
- Monitor chest tube output if using ketorolac; consider pausing if drainage exceeds 50ml/hour 2
- For patients with higher bleeding risk, prioritize acetaminophen alone as it provides effective analgesia without affecting platelet function 2
Rescue Medication
- Use opioids only as rescue medication when first-line treatments are insufficient 3
- Options include morphine PCA for the first 24 hours, transitioning to oral opioids as needed 3
Catheter Management
- Remove urethral catheter on postoperative day 4 4
- Earlier catheter removal (day 3 vs. day 5) is associated with less urethral discomfort and pain at discharge 3
- Monitor for spontaneous voiding after catheter removal; be prepared to replace temporarily if retention occurs 4
Drain Management
- Remove surgical drains after approximately 3-4 days when drainage is minimal 5
- Monitor drain output for excessive bleeding that might require intervention 6
Fast-Track Protocol Elements
- Implement early mobilization to reduce pain during rest and movement 3
- Begin oral intake as soon as bowel function returns 6
- Consider COX-2 inhibitors (e.g., celecoxib) as part of a fast-track protocol for patients without contraindications 3, 7
Preemptive Analgesia Considerations
- For future cases, consider implementing preemptive analgesia with pregabalin 150mg, acetaminophen 975mg, and celecoxib 400mg given 2 hours before surgery 7
- This approach has been shown to significantly reduce both intraoperative and postoperative opioid requirements 7
Monitoring and Complications
- Assess pain scores regularly using standardized scales (VAS/NRS) 3
- Monitor for postoperative bleeding, which may require transfusion in approximately 1% of cases 6
- Watch for bowel complications, which occur in approximately 1% of robotic prostatectomy patients 6
- Evaluate urinary function after catheter removal using uroflowmetry and symptom scores at 6 weeks and 3 months 4