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Robotic Cancer Postsurgery Pain Management

Specialized Program Manages Urologic Cancer Surgery With No, or Fewer, Narcotics

Newswise — A specialized pain management program for patients who underwent robotic surgery for urologic cancers resulted in just eight percent going home with narcotics after discharge, compared to 100 percent who would have received them without this enhanced recovery protocol. What’s more, the group of patients who did receive narcotics went home with fewer pills than they would have under regular guidelines. Researchers in the Perelman School of Medicine at the University of Pennsylvania will present their findings at the 2019 American Society of Clinical Oncology Annual Meeting in Chicago (Abstract #6502).

“The key to our program was to start patients with over the counter medications, then escalate them as needed. This means patients whose pain can be managed without opioids never end up getting them in the first place, while patients whose pain warrants these prescriptions receive them when needed,” said lead author Ruchika Talwar, MD, a resident in Urology. Thomas J. Guzzo, MD, MPH, chief of Urology, is the study’s senior author.

Cancer patients are particularly susceptible to opioid addiction, with recent studies showing they are 10 times more likely to die from an opioid overdose than the general public. About six percent of cancer patients who use opioids for the first time to manage pain after a surgery become addicted.

This study specifically looked at robotic urological procedures, including radical prostatectomy to remove the prostate and both radical nephrectomy and partial nephrectomy to remove or partially remove the kidney. In all of these cases, guidelines indicate sending patients home with varying amounts of oxycodone – between 15 and 45 pills. 

In September of 2018, Penn researchers began a new program that started patients without narcotics and escalated only if needed. Patients received gabapentin and acetaminophen before surgery, then received the drugs…

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