Pain Scores and Opioid Consumption after Robotic-assisted Abdominal Surgery: A Single Centre Historical Cohort Study

Effective postoperative pain control is essential for recovery. Pain has long been considered the "fifth vital sign" in the United States, making its assessment routinely documented. However, data on pain and opioid consumption following robotic-assisted surgeries remain limited despite their widespread adoption. This study evaluated pain scores and opioid consumption in patients undergoing intermediate-risk robotic-assisted abdominal, urological, or gynecological procedures. We hypothesized that pain would be minimal (numerical rating scale (NRS < 4)) and opioid use low (<5 morphine milligram equivalents (MME) within 24 h post-surgery).

This historical cohort study included consecutive adult patients who underwent intermediate-risk robotic-assisted abdominal, urological, or gynecological surgery between 2013 and 2024. Co-primary endpoints were the maximal NRS and total opioid consumption (MME) at the end of the day of surgery (POD 0). Secondary endpoints included maximal NRS and total MME at the end of postoperative day 1 (POD 1) and the incidence of nausea and vomiting (PONV) in the post-anesthesia care unit.

Among 9,978 cases (57% urological, 34% gynecological, 9% abdominal), median [Q1-Q3] maximal NRS and total MME were 7 [5-8] and 10 mg [5-15] on POD 0, and 6 [4-7] and 8 mg [0-12] on POD 1. PONV occurred in 11% of patients CONCLUSIONS: Contrary to the initial hypothesis, patients undergoing intermediate-risk robotic-assisted procedures experienced higher-than-expected pain scores and moderate opioid consumption on the day of surgery, emphasizing the need to optimize multimodal analgesic strategies for robotic surgery in our center.