Pain Management After Robotic Urologic Surgery

After surgery, patients commonly have pain from inflammation caused by trauma to the body’s tissues. The goal of post-operative pain control is to decrease pain and discomfort with minimal side effects. A combination of treatment options has been shown to be more effective than using opioid medications alone.

In the past, patients were treated primarily with opioid medications, such as Percocet (oxycodone-acetaminophen), Vicodin (hydrocodone-acetaminophen), oxycodone, morphine, and hydromorphone. These medications are effective in relieving pain but have numerous side effects, such as nausea, vomiting, constipation, itching, difficulty breathing, and confusion. In addition, opioids can be highly addictive medications. By reducing and potentially eliminating them after minimally invasive urologic surgery, patients have better outcomes overall. 

By using several different types of medications, opioids can be limited and even eliminated from post-operative pain regimens. Common types of adjunct medications include nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, local anesthetics, and antispasmodics. Using these medications on a scheduled basis, not merely as needed, can reduce and eliminate the need for opioid medications. 

Benefits of Commonly Prescribed Medications

NSAIDs act by decreasing the body’s inflammatory response after surgery. Common NSAIDs are ibuprofen, ketorolac, and diclofenac. These medications cannot be given to patients who have poor kidney function and patients who have a high risk of bleeding after the surgery. After minimally invasive urologic surgery there is usually a low risk of bleeding, so NSAIDs are used. These medications can be given orally or through an intravenous line. The addition of NSAIDs alone can decrease opioid use by almost 50%. 

Acetaminophen also reduces the body’s inflammatory response after surgery, but differently than NSAIDs. Acetaminophen can be administered as an oral tablet or through an intravenous (IV) line. Both routes are equally effective. The IV preparation is used immediately after surgery when patients have trouble tolerating oral medications. As soon as a patient can tolerate oral medication, they are typically transitioned to oral medications. Acetaminophen is safe for use with patients who have altered kidney function, but is avoided in patients with a history of liver disease. 

NSAIDs and acetaminophen are frequently used together. Although they have different mechanisms of reducing inflammation, they work very well to assist with pain control after minimally invasive urologic surgery. Both can reduce the need for opioid medications.

Local anesthesia is commonly injected around the surgical incisions. Local anesthesia administration can decrease the amount of pain medication required after surgery. It also can increase the amount of time until a patient first requests additional pain medication. Topical lidocaine patches or gels are also used to provide anesthesia at the surgical incisions. 

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