Intravesical Ropivacaine as a Novel Means of Analgesia Post–Robot-Assisted Radical Prostatectomy: A Randomized, Double-Blind, Placebo-Controlled Trial

This study evaluates the safety and efficacy of intravesical ropivacaine as part of a mulitimodal approach to the provision of analgesia after robot-assisted radical prostatectomy (RARP).In this double-blind, placebo-controlled trial, 40 patients who were scheduled to undergo RARP for treatment of localized prostate cancer by a single surgeon (SP) were randomized 1:1 to receive either alkalinized intravesical ropivacaine or placebo (0.9% sodium chloride) at the completion of the vesicourethral anastomosis. A standardized general anesthetic was administered in each case. The primary outcome was a reduction in postoperative pain as assessed by a visual analogue scale (VAS). The need for alternate analgesic agents was recorded. Adverse events related to the administration of intravesical ropivacaine were documented prospectively.No serious adverse events related to the administration of intravesical ropivacaine were identified. In the ropivacaine group, there was a significant reduction in the cumulative needed dose of ketoralac relative to placebo at 6 hours postoperatively. There was no statistically significant difference between the groups with regard to pain scores or narcotic use at any time point.Intravesical administration of ropivacaine may be used safely in the context of RARP and is associated with a significant, albeit modest reduction in the need for supplementary analgesic agents, but did not result in a decrease in postoperative pain scores.