BUPIVACAINE INFILTRATION INTO THE NEUROVASCULAR BUNDLE OF THE PROSTATIC NERVE DOES NOT IMPROVE POSTOPERATIVE PAIN OR RECOVERY FOLLOWING TRANSVESICAL PROSTATECTOMY

Purpose: We assessed the effect of intraoperative bupivacaine infiltra tion into the neurovascular bundle of the prostatic nerve on postopera tive pain and patient outcome. Materials and Methods: The study includ ed 40 American Society of Anesthesiologists physical status I to III p atients undergoing transvesical prostatectomy. Following surgical rese ction of the prostate the neurovascular bundle of the prostatic nerve was infiltrated with either 10 mi. bupivacaine 0.5% or saline. Postope rative pain intensity was assessed using a patient generated 100 mm. v isual analog scale and a patient controlled analgesia device. Addition al analgesic requirements, time to ambulation, length of hospitalizati on and return to normal activity were also recorded. Results: There we re no differences in visual analog scale for pain, patient controlled analgesia demands or actual morphine delivered. Similarly, saline vers us bupivacaine infiltration did not influence ambulation time (21.3 +/ - 2.7 versus 25.0 +/- 11.8 hours, respectively), length of hospitaliza tion (7.06 +/- 0.8 versus 7.11 +/- 0.6 days, respectively), return to normal activity (14.4 +/- 8.8 versus 14.2 +/- 8.2 days, respectively) or patient satisfaction. On postoperative days 1 and 2 more patients i n the saline treatment group requested additional oral analgesia compa red to the bupivacaine treatment group. However, no statistical differ ence was demonstrated. Conclusions: Following transvesical prostatecto my, prostatic nerve blockade has no beneficial effects on postoperativ e pain or patient outcome.