Impacto de la lidocaína endovenosa en el manejo del dolor postoperatorio de prostatectomía radical por cirugía robótica en el Hospital Universitario Fundación Santa Fe de Bogotá de 2017 a 2018

Abstract

Introduction. Minimally invasive techniques have been a revolution in the history of surgery, improving outcomes with less tissue injury and better pain control. Multimodal pain control techniques have also shown a better recovery of the surgical patient. Intravenous lidocaine is an alternative as multimodal analgesia, with evidence in abdominal surgery, mainly colectomy and open prostatectomy, generating lower opioid consumption and fewer adverse effects. Little is known about the impact of the use of intravenous lidocaine in the control of postoperative pain of prostatectomy by robot. Objective. To evaluate the impact of intravenous lidocaine in the management of post-operative pain in patients undergoing radical prostatectomy by a minimally invasive (robotic) technique during 2017 and 2018 at the Santa Fe de Bogotá University Hospital. Design, materials and methods. Study of quantitative approach, analytical observational, prospective cohort type. Patients older than 18 years old, taken to prostatectomy by robot. As a primary outcome, the intensity of postoperative pain was compared using a visual analogue scale between the groups of patients exposed or not to intravenous lidocaine. Results 92 patients were collected. 47 had received lidocaine (51.1%). A significant association was found between the use of lidocaine and the lower manifestation of moderate to severe pain: RR (95% CI): 0.19 (0.10 to 0.37). It was also associated with lower opioid consumption, early ambulation and peristalsis, and shorter hospital stay (p <0.05). The multivariate analysis to explain the appearance of pain, showed as protective factor the use of lidocaine, and as a risk factor the BMI (Nagelkerke's R2 0.597, AUC 88.4%). Conclusions.