An Enhanced Recovery After Surgery protocol for robotic-assisted laparoscopic nephrectomies utilizing a quadratus...

Area of Science:

• Urology
• Anesthesiology
• Surgical Oncology

Background:

• Enhanced Recovery After Surgery (ERAS) protocols aim to shorten hospital stays and reduce costs.
• Multimodal analgesia strategies are crucial for minimizing opioid consumption post-surgery.
• Robotic-assisted laparoscopic nephrectomies present opportunities for optimizing perioperative care.

Purpose of the Study:

• To evaluate the impact of an ERAS protocol, including a quadratus lumborum (QL) block and multimodal analgesia, on opioid consumption and perioperative outcomes.
• To compare outcomes in patients undergoing robotic-assisted partial or radical nephrectomies before and after ERAS protocol implementation.

Main Methods:

• Retrospective review of 614 patients undergoing robotic-assisted laparoscopic partial or radical nephrectomies.
• Comparison of 192 patients under the ERAS protocol (multimodal analgesia + QL block) with 422 non-ERAS patients.
• Analysis of opioid consumption, surgery length, hospitalization duration, and complication rates.

Main Results:

• ERAS protocol initiation led to statistically significant reductions in opioid consumption on postoperative days 0, 1, and 2.
• Total opioid requirements during admission were significantly lower in the ERAS group.
• No significant differences were observed in surgery length, hospitalization length, or complication rates between groups.

Conclusions:

• An ERAS protocol incorporating multimodal analgesia and a QL block effectively decreases opioid requirements for robotic nephrectomies.
• This enhanced recovery strategy can be implemented without compromising key perioperative outcomes.
• The findings support the adoption of ERAS protocols for optimizing pain management in urologic robotic surgery.