Dr. Laviana on pain management protocol following robotic urologic surgery


"One of the biggest surprises was just how ubiquitous prescribing narcotics in all phases were, from intraoperatively to the PACU to postoperatively," says Aaron A. Laviana, MD, MBA.

In this video, Aaron A. Laviana, MD, MBA, describes research on pain management following robotic urologic surgery presented at the 2023 Society of Urologic Oncology Annual Meeting. Laviana is an assistant professor in the Department of Surgery and Perioperative Care at Dell Medical School at the University of Texas at Austin.


Please describe the rationale for this research.

I've been in practice now for 3 years, and when I started at the University of Texas at Austin, there was no standardized procedure in how we managed robotic urologic surgery postoperatively; it was more of a sort of potpourri. We run a co-management service with hospitalists, and so patients are primarily admitted to the hospitalist. And with a large number of providers there, there was just no pathway for patients in that regard for how they're managed from a pain standpoint. And with the opioid crisis being more and more relevant, we really wanted to see, can we optimize patient care, can we move toward going narcotic free, but doing it in A. in a way that was easy to disseminate? When you look at the old literature, there were opiate-free regimens, but they were convoluted, complex, and unclear [as to] which medications really had the most value. So that was important, and then B., if we're going to do this, we want to make sure that, from a patient satisfaction standpoint, they were not being adversely affected, and that their outcomes were good, not only oncologically, but from a quality-of-life standpoint as well.

What were some of the notable findings? Were any of them surprising to you and your coauthors?

The first piece to this was we really wanted to see what our outcomes were like in the current format. So we don't want to change anything until we get a better understanding of our current landscape. And one of the biggest surprises was just how ubiquitous prescribing narcotics in all phases were, from intraoperatively to the PACU to postoperatively. And then, when we implemented our opioid minimization protocol, we really wanted a regimen that just focused on 3 simple components. One is the acetaminophen or Tylenol every 8 hours, and then ibuprofen every 8 hours, and then a muscle relaxant every 8 hours. And we didn't want to do a scenario where a patient was taking a medication every 3 hours and trying to figure out what do they do for Tylenol, what do they do for ibuprofen. We wanted to just make it so every 8 hours, they took everything together. One of the things that surprised us was just how easy that was to do for the patient and how much they really enjoyed that schedule vs before. And then by reducing these narcotics to almost 0, just how good the patients felt and how really minimal sort of deficits postoperatively.

This transcription was edited for clarity.

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