Spinal Analgesia Versus Intravenous Low-Dose Oxycodone for Pain Management After Robotic Hysterectomy: Preliminary Results from an ERAS Institution

Abstract

Background: Robotic hysterectomy and Enhanced Recovery After Surgery (ERAS) are two significant improvements in gynecologic surgery, both associated with decreased postoperative pain and faster recovery. Spinal analgesia guarantees excellent pain coverage; however, its appropriateness in robotic procedures is still controversial. The aim of the study was to compare postoperative pain control after robotic hysterectomy in patients receiving spinal analgesia versus intravenous low-dose oxycodone. Methods: Consecutive patients undergoing robotic hysterectomy from January 2022 to July 2023 were included in the analysis. Until August 2022, patients received spinal analgesia, while from September 2022, low-dose oxycodone was administered intraoperatively. All patients were managed following the ERAS protocol. Primary outcomes were the VAS pain score and opioid rescue use, while secondary outcomes included postoperative nausea and vomiting (PONV), mobilization, oral intake, and length of hospital stay (LOS). Results: Of 114 patients, 67 (58.8%) received spinal analgesia and 47 (41.2%) received intravenous low-dose oxycodone. No differences were reported in the VAS pain score at day 0 (1.5 ± 1.6 vs. 1.6 ± 2.2, p = 0.78) and day 1 (2.0 ± 2.1 vs. 1.3 ± 1.8, p = 0.07). At day 2, the VAS pain score was 1.4 ± 1.6 in the spinal analgesia group and 0.7 ± 1.0 in the oxycodone group (p = 0.01). No differences were reported in the need for opioid rescue at days 1 and 2 (p = 1.00). At day 0, 26 patients (38.8%) experienced PONV in the spinal analgesia group versus 8 (17.0%) in the oxycodone group (p = 0.01). Conclusions: Patients receiving intraoperative low-dose oxycodone experienced comparable satisfactory postoperative pain control with a lower incidence of PONV when compared to the spinal analgesia group.