Postoperative pain and neuromuscular complications associated with patient positioning after robotic assisted laparoscopic radical prostatectomy: a retrospective non-placebo and non-randomized study.

PURPOSE

To evaluate postoperative pain and neuromuscular complications associated with positioning after robotic assisted laparoscopic radical prostatectomy (RALP).

METHODS

Between September 2010 and June 2014, 534 patients who underwent RALP were evaluated. Patients were positioned in operating theater by operating room staff, and two independent urologists noted postoperative follow-up. Patient's demographic data, postoperative complications associated with positioning, pain score according to visual analogue scale, and hospital stay were recorded. Statistical analyses were performed and p < 0.05 was considered significant.

RESULTS

Postoperative pain and neuromuscular complications were observed in 54 (10.1 %) and 27 (5 %) patients, respectively. We found ASA, BMI, and comorbidities were significantly associated with postoperative pain levels in univariate analyses (p = 0.01, p = 0.013, and p = 0.01, respectively). Additionally, ASA, previous operations, and comorbidities were significantly associated with postoperative neuromuscular complications (p = 0.04, p = 0.01, and p = 0.02, respectively). According to statistical analyses, BMI < 30 and presence of an implant were significantly associated with postoperative pain in multivariate logistic regression analyses (p = 0.010 and p = 0.033, respectively). Additionally, having comorbidities was significantly associated with postoperative neuromuscular complications in multivariate analyses (p = 0.04).

CONCLUSIONS

Patients with previous operations, comorbidities, and high ASA score are at risk of neuromuscular complications during RALP. Lower BMI and having an implant also lead to higher postoperative pain. Operating room staff and anaesthesia team should be very careful with patients undergoing RALP in steep Trendelenburg and low-lithotomy position.