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Korean J Anesthesiol > Epub ahead of print
DOI: https://doi.org/10.4097/kja.22821    [Epub ahead of print]
Published online June 14, 2023.
Robot-assisted radical prostatectomy: comparison of subarachnoid analgesia, erector spine plane block, and intravenous analgesia for postoperative pain management
Pasquale Buonanno1, Nicola Logrieco1, Annachiara Marra1, Lorenzo Spirito2, Gianluigi Califano2, Federica Blasio1, Nausica Di Falco1, Achille Aveta2, Gianluca Spena2, Giuseppe Servillo1
1Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Naples, Italy
2Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy
Corresponding author:  Lorenzo Spirito, Tel: +39 3383189011, 
Email: lorenzospirito@msn.com
Received: 27 December 2022   • Revised: 7 February 2023   • Accepted: 7 February 2023
*Pasquale Buonanno and Nicola Logrieco contributed equally to this study as co-first authors.
Laparoscopic and robotic prostatectomy allows a higher precision and a magnified view of the surgical field but it did not show to be characterized by a lower pain compared to open surgery so the management of postoperative pain still remains an important issue.
We enrolled 60 patients randomized in 1:1:1 ratio into three groups: group SUB: treated with a lumbar subarachnoid injection of 10.5 mg ropivacaine, 30 μg clonidine, 2 μg/kg morphine, and 0.03 μg/kg sufentanil; groups ESP: treated with a bilateral erector spinae plane (ESP) block with 30 μg clonidine, 4 mg dexamethasone, 100 mg ropivacaine; group IV: treated with 10 mg morphine intramuscular 30 minutes before the end of the surgery and a postoperative iv continuous infusion of 0.625 mg/hr morphine in the first 48 hours after the intervention.
Numeric rating scale score in the first 12 hours after intervention was significantly lower in SUB group compared to both IV group and ESP group with a maximum difference at 3 hours after intervention (0.14±0.35 vs 2.05±1.10, P <0.001 and 0.14±0.35 vs 1.15±0.93, P <0.001, respectively). Intraoperative supplemental doses of sufentanil were not required by SUB group, whereas IV and ESP groups required an additional dose of 24±10.7 μg and 7.5±5.5 μg, respectively (P <0.001).
Subarachnoid analgesia is an effective strategy to manage postoperative pain in robot-assisted radical prostatectomy; it allows to reduce both intraoperative and postoperative opioid consumption and the amount of inhalation anesthetics compared to intravenous analgesia. ESP block might be an effective alternative in patients with contraindications to subarachnoid analgesia.
Key Words: Erector spinae plane block; Intravenous analgesia; Opioids; Postoperative pain; Robotic assisted radical prostatectomy; Subarachnoid analgesia


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