Initial experience with ketamine-based analgesia in patients undergoing robotic radical cystectomy and diversion

Authors

  • Kenneth Jacobsohn
  • Tanya D. Davis Children's National Medical Center, Washington D.C.
  • Ahmad M. El-Arabi Medical College of Wisconsin, Milwaukee, WI
  • Jonathan Tlachac Medical College of Wisconsin, Milwaukee, WI
  • Peter Langenstroer Medical College of Wisconsin, Milwaukee, WI
  • R Corey O'Connor Medical College of Wisconsin, Milwaukee, WI
  • Michael L. Guralnick Medical College of Wisconsin, Milwaukee, WI
  • William A. See Medical College of Wisconsin, Milwaukee, WI
  • Robert Schlosser Medical College of Wisconsin, Milwaukee, WI

DOI:

https://doi.org/10.5489/cuaj.2790

Keywords:

ketamine, cystectomy, RARC, opioid

Abstract

Introduction: We instituted a ketamine-predominant analgesic regimen in the peri- and postoperative periods to limit the effects of narcotic analgesia on bowel function in patients undergoing radical cystectomy. The primary end points of interest were time to return of bowel function, time to discharge, and efficacy of the analgesic regimen.

Methods: We performed a retrospective chart review of patients undergoing robotic-assisted laparoscopic cystectomy (RARC) with urinary diversion by a single surgeon at our institution from January 1, 2011 to June 30, 2012. Patients receiving the opioid-minimizing ketamine protocol were compared to a cohort of patients undergoing RARC with an opioid-predominant analgesic regimen.

Results: In total, 15 patients (Group A) were included in the ketamine-predominant regimen and 25 patients (Group B) in the opioid-predominant control group. Three patients (19%) in Group A discontinued the protocol due to ketamine side effects. The mean time to bowel movement and length of stay in Group A versus Group B was 3 versus 6 days (p < 0.001), and 4 versus 8 days, respectively (p < 0.001). Group A patients received an average of 13.0 mg of morphine versus 97.5 mg in Group B (p < 0.001).

Conclusions: Patients who received our ketamine pain control regimen had a shorter time to return of bowel function and length of hospitalization after RARC. Our study has its limitations as a retrospective, single surgeon, single institution study and the nonrandomization of patients. Notwithstanding these limitations, this study was not designed to show inferiority of one approach, but instead to show that our protocol is safe and efficacious, warranting further study in a prospective fashion.

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Author Biographies

Tanya D. Davis, Children's National Medical Center, Washington D.C.

Pediatric Urology Fellow

Ahmad M. El-Arabi, Medical College of Wisconsin, Milwaukee, WI

Department of Urology

Jonathan Tlachac, Medical College of Wisconsin, Milwaukee, WI

Assistant Professor, Department of Anesthesiology

Peter Langenstroer, Medical College of Wisconsin, Milwaukee, WI

Professor, Department of Urology

R Corey O'Connor, Medical College of Wisconsin, Milwaukee, WI

Associate Professor, Department of Urology

Michael L. Guralnick, Medical College of Wisconsin, Milwaukee, WI

Associate Professor, Department of Urology

William A. See, Medical College of Wisconsin, Milwaukee, WI

Professor, Department of Urology

Robert Schlosser, Medical College of Wisconsin, Milwaukee, WI

Assistant Professor, Department of Anesthesiology

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Published

2015-06-18

How to Cite

Jacobsohn, K., Davis, T. D., El-Arabi, A. M., Tlachac, J., Langenstroer, P., O’Connor, R. C., Guralnick, M. L., See, W. A., & Schlosser, R. (2015). Initial experience with ketamine-based analgesia in patients undergoing robotic radical cystectomy and diversion. Canadian Urological Association Journal, 9(5-6), E367–71. https://doi.org/10.5489/cuaj.2790

Issue

Section

Original Research