[Perioperative analgesia in urology and potential influence of anesthesia on oncologic outcomes of surgery]. / Analgésie peropératoire en urologie et influence potentielle de l'anesthésie sur les résultats de la chirurgie carcinologique.

INTRODUCTION: The objective of the current article was to present a review concerning current concepts of perioperative analgesia in urology and to assess the potential influence of anesthesia on oncologic outcomes after surgery. PATIENTS AND METHODS: Data on general anesthesia and perioperative analgesia were explored on Medline using the following MeSH terms: anesthesia; analgesia; pain urology; cancer; morphine; nefopam; tramadol; ketamine; local anesthetics; non-steroid anti-inflammatory treatments; surgery; cancer. Publications were considered on the following criteria: methodology, relevance and date of publication. RESULTS: The concepts of acute and chronic pain after surgery are discussed, as well as prevention and treatment. Types of available pharmacological substances are listed and the possible routes of administration for these products. The concept of multimodal analgesia and preemptive analgesia are exposed and their role for the prevention of perioperative pain. Recent studies suggest a relationship between the modes of anesthesia and analgesia in cancer surgery, and recurrence of the disease after surgery. CONCLUSION: Current concepts of perioperative analgesia offer new perspectives to urologists in the management of pain. Current scientific literature advocates regional anesthesia, the fight against pain and stress, and decreased use of opioids. In addition, the use of a multimodal analgesia seems to be an option for an optimal oncologic management of urologic tumours.

[Prevention of complications of general anesthesia linked with laparoscopic access and with robot-assisted radical prostatectomy]. / Complications de l'anesthésie générale inhérentes à la voie laparoscopique et à la prostatectomie totale robot-assistée.

INTRODUCTION: The aim of our work was to present a review of technical features and complications of general anesthesia during robot-assisted laparoscopic radical prostatectomy (RALRP). MATERIALS AND METHODS: Data on RALRP and general anesthesia were explored on Medline using the following MeSH terms: radical prostatectomy; morbidity; anesthesia complications; laparoscopy; robotics; Trendeleburg. Publications were considered on the following criteria: methodology, relevance and date of publication. RESULTS: There was no data of level of evidence 1 available. The first RALRP was reported in 2000. Technological innovation brought by the robot with its 3-D vision, the acquisition of degrees of mobility and a more ergonomic position for the surgeon, have led to a growing interest from new teams in the western world. However, the RALRP generates constraints for the anesthesia team who need to incorporate the rules of laparoscopy and the patient's specific installation to guarantee maximum safety. There are inherent complications with the installation of the patient himself in the Trendelenburg position (ocular, neurological, hemodynamic, respiratory) and respiratory complications related to the specific procedure in gaseous atmosphere due to pneumoperitoneum. One of the criteria of the quality of publications in the field of surgery is related to the objective evaluation of complications by appropriate scale systems and the complications of general anesthesia must also be absolutely recorded. CONCLUSION: RALRP had deeply modified the anatomical landmarks of the surgical removal of prostate cancer. However, the perioperative environment has also been completely altered and the installation of RALRP in the daily routine of a service requires from the anesthesia team to adapt their behavior to this sophisticated surgical access.