Introduction:

The implementation of robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) for management of patients with muscle-invasive (MIBC) or high-risk non-invasive (NMIBC) bladder cancer has increased in utilization over the last decade. Here, we seek to describe institutional opioid prescription and utilization patterns following implementation of a nonopioid (NOP) perioperative pain management protocol in patients who received RARC with ICUD.

Methods:

The records of all patients who underwent RARC that utilized a non-opioid perioperative pain management protocol at a single academic institution from 2016 to 2020 were retrospectively reviewed. Descriptive statistical analyses were performed.

Results:

A total of 116 patients who received ICUD were included in our analysis. The median operation time for the ICUD group was 305 minutes (IQR: 262-352). 12.1% (n = 14) of patients required narcotics during inpatient hospitalization. For these patients, the median morphine milligram equivalent (MME) requirement was 52.0 (IQR: 7.62-157). Additionally, only 12.1% (n = 14) of patients were prescribed opioids post-operatively at discharge. We identified that within 6 months of surgery only 5 (4.3%) patients required a second narcotic prescription. Furthermore, of patients who did not use mu-opioid blockers, a minority experienced post-operative ileus (15.7%, n = 16). 30- and 90-day all Clavien complication rates for patients were 44.8% (n = 52) and 49.1% (n = 57), respectively. Nineteen (16.4%) patients were readmitted within 30 days, of which none were pain related. Table 1 shows the characteristics and perioperative outcomes of all patients who underwent RARC with ICUD.

Conclusion:

RARC with ICUD allows for both decreased postoperative narcotics use and reduced need for narcotic prescriptions at discharge with acceptable complication and readmission rates.

Funding: N/A