Robot-assisted radical prostatectomy: comparison of subarachnoid analgesia, erector spine plane block, and intravenous analgesia for postoperative pain management.

Background: Laparoscopic and robotic prostatectomy allows a higher precision and a magnified view of the surgical field but it did not show to be characterized by a lower pain compared to open surgery so the management of postoperative pain still remains an important issue. Methods: We enrolled 60 patients randomized in 1:1:1 ratio into three groups: group SUB: treated with a lumbar subarachnoid injection of 10.5 mg ropivacaine, 30 µg clonidine, 2 µg/kg morphine, and 0.03 µg/kg sufentanil; groups ESP: treated with a bilateral erector spinae plane (ESP) block with 30 µg clonidine, 4 mg dexamethasone, 100 mg ropivacaine; group IV: treated with 10 mg morphine intramuscular 30 minutes before the end of the surgery and a postoperative iv continuous infusion of 0.625 mg/hr morphine in the first 48 hours after the intervention. Results: Numeric rating scale score in the first 12 hours after intervention was significantly lower in SUB group compared to both IV group and ESP group with a maximum difference at 3 hours after intervention (0.14±0.35 vs 2.05±1.10, P <0.001 and 0.14±0.35 vs 1.15±0.93, P <0.001, respectively). Intraoperative supplemental doses of sufentanil were not required by SUB group, whereas IV and ESP groups required an additional dose of 24±10.7 µg and 7.5±5.5 µg, respectively (P <0.001). Conclusions: Subarachnoid analgesia is an effective strategy to manage postoperative pain in robot-assisted radical prostatectomy; it allows to reduce both intraoperative and postoperative opioid consumption and the amount of inhalation anesthetics compared to intravenous analgesia. ESP block might be an effective alternative in patients with contraindications to subarachnoid analgesia.

The economic impact of the introduction of universal rotavirus vaccination on rotavirus gastroenteritis related hospitalisations in children in Ireland.

BACKGROUND: Rotavirus gastroenteritis (RVGE), a vaccine preventable disease, remains a common cause of severe gastroenteritis in children globally. Ireland introduced the universal rotavirus vaccination to the national immunisation programme in 2016. In this paper the economic impact on RVGE related hospitalisations amongst children under 5 years is examined. METHODS: Using national data from all Irish public hospitals, an Interrupted Times Series Analysis (ITSA) compares RVGE hospitalisations amongst children under 5 years, pre- and post-vaccine introduction. Costs are estimated and ITSA results are compared to the counterfactual to estimate the economic impact of the vaccine. A probit model examines patient characteristics pre- and post-vaccine introduction. RESULTS: Vaccine introduction coincided with lowered RVGE related hospitalisations. While this effect was delayed (1 year) there is evidence of a sustained impact. RVGE patients' post-vaccine introduction were likely to be over 2 years (p = 0.001) and length of stay was lower on average (p = 0.095). The counterfactual analysis revealed 492 RVGE hospitalisations were avoided on average annually since the introduction of the vaccine. This has an estimated economic value of €0.92 million per annum. CONCLUSIONS: Following the introduction of the rotavirus vaccine in Ireland, hospitalisations for RVGE decreased significantly and those hospitalised were older and with a reduced length of stay on average. This has the potential for significant cost savings for the Irish healthcare system.