Impact of analgesic techniques on early quality of recovery after prostatectomy: a 3-arm, randomised trial.

BACKGROUND

Prostatectomy is associated with relevant acute postoperative pain. Optimal analgesic techniques to minimise 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, randomised, three-arm, parallel group, active controlled, interventional superiority trial was performed in a Swiss teaching hospital from 2018-2021. Consecutive patients undergoing open or robotic-assisted radical prostatectomy were randomised 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 where similar in all groups. At discharge, median QoR-15 scores were considered as good (>122) in all groups: SSS 134 [IQR 128 to 138]; TAP 129 [IQR 122 to 136] and SA 128 [IQR 123 to 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.