Optimized Anesthesia and Analgesic Regimen for Robotic Colorectal Surgery

Abstract

Robotic surgery has recently been introduced for colorectal procedures. In robotic colorectal surgery, only a few low-powered randomized studies have been performed, demonstrating equal short-term surgical outcomes. Robotic surgery offers specific technical advantages; however, studies have documented increased operative time and economic costs compared to both open and laparoscopic colorectal surgery. At the moment, no randomized studies, cohort studies or case-series have investigated outcomes related to anesthesia or analgesic treatment in robotic colorectal surgery. Experience and transferable evidence from laparoscopy and other fields of robotic surgery, such as urology and gynecology may provide valuable information when introducing this new technique. This review presents an overview of the anesthesiological challenges during robotic colorectal surgery. Furthermore, clinical recommendations are presented in relation to patient preparation, patient safety, anesthetic treatment, and postoperative pain management. This review recommends total intravenous anesthesia, including propofol and ultra-fast acting opioids. Moreover, neuromuscular blocking agents for complete (deep) block are mandatory. For postoperative analgesic treatment, a multimodal regimen including dexamethasone, paracetamol, COX-1selective NSAIDs, oral opioids is recommended. Clinical effects and the administration routes of local anesthetics must be investigated further. In general, focus of the clinician should be drawn towards the preparation phase before surgery and knowledge of the physiological changes and patient handling in relation to Trendelenburg positioning and pneumoperitoneum. Lessons learned from laparoscopic colorectal surgery can be applied with respect to anesthetic- and postoperative analgesic treatment until further evidence is provided.