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Use of a specific questionnaire and perineal electromyography to assess neuropathic pain after radical retropubic prostatectomy.

ABSTRACT: Objective:Prostate cancer is the most frequent cancer in men and radical retropubic prostatectomy (RRP) is one of the first-line treatment. However, RRP has some side effects and can lead to chronic perineal pain. The objective of the study was to determine in patients suffering from perineal pain after RRP the possibility of a neurogenic damage by means of a specific questionnaire dedicated to track down neuropathic pain. Methods:Forty patients were explored by a specific and validated questionnaire, the Neuropathic Pain Symptom Inventory (NPSI). Patients were divided into two groups: Group A with an NSPI score ?4 was considered as suffering from neuropathic pain, and Group B was considered as a control group without neuropathic pain (NSPI score <4). All patients had a perineal electrophysiological testing to confirm the possibility of a neurogenic damage. Results:Group A was composed by 13 men and Group B by 27 men, with mean age 72.45 years and mean duration of pain 2.7 years. In Group A, the most frequent symptoms were burning sensation, electrical shock and numbness. Location of the pain was global perineal area (8/13), anus (10/13), penis (5/13) and glans penis (2/13). Electromyography (EMG) findings confirmed the presence of denervation and neurogenic damages compared with controls (p < 0.001). Conclusion:One third of the patients consulting for chronic pain following RRP had probably a neuropathic lesion leading to a chronic perineal pain as suggested by an NSPI score ? 4 and EMG alterations.

SUBMITTER: Turmel N

PROVIDER: S-EPMC6872839 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

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Use of a specific questionnaire and perineal electromyography to assess neuropathic pain after radical retropubic prostatectomy.

Turmel Nicolas N Ismael Samer Sheikh SS Chesnel Camille C Charlanes Audrey A Hentzen Claire C Le Breton Frédérique F Amarenco Gérard G

Asian journal of urology 20180621 4

<h4>Objective</h4>Prostate cancer is the most frequent cancer in men and radical retropubic prostatectomy (RRP) is one of the first-line treatment. However, RRP has some side effects and can lead to chronic perineal pain. The objective of the study was to determine in patients suffering from perineal pain after RRP the possibility of a neurogenic damage by means of a specific questionnaire dedicated to track down neuropathic pain.<h4>Methods</h4>Forty patients were explored by a specific and val ...[more]

PMID: 31768323

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Project description:BackgroundSpinal anaesthesia preceding general anaesthesia has been conducted for open radical retropubic prostatectomy (RRP) to decrease immediate postoperative pain for many years. Nevertheless, the effectiveness of spinal anaesthesia to reduce postoperative opioid requirements remains unknown. The aim of the present study was to determine the effect of spinal anaesthesia preceding general anaesthesia on opioid requirements, postoperative pain and biochemical cancer-free survival.MethodsThis before-and-after effectiveness study investigated effects of two different anaesthesia techniques in 636 patients with RRP. Three hundred eighteen consecutive patients in the SPA group (spinal anaesthesia preceding general anaesthesia) were compared with 318 patients in the GA group (general anaesthesia alone). The primary endpoint of the study was opioid consumption in the post-anaesthesia care unit. Secondary endpoints were intraoperative opioid consumption, postoperative pain, postoperative recovery time, the length of hospital-stay, persistence of pain 1 year after surgery and cancer-free survival. Differences between the groups were analysed by a two-sided t-test, χ2-test, Fisher's exact test and Mann-Whitney U test and the influence of possible confounders on opioid consumption with a general linear model. Cancer-free survival was determined by Kaplan-Meier curves and group differences by log-rank tests and multivariable Cox regression analyses.ResultsThe total amount of morphine equivalent administered postoperatively was 7.5 [6.9; 8.1] mg in the SPA group and 6.0 [5.5; 6.5] mg in the GA group (mean [95% CI], p < 0.001). The amount of intraoperative sufentanil was 56.9 [55.1; 58.7] μg in the SPA group and 84.5 [82.5; 86.5] μg in the GA group (mean [95% CI], p < 0.001). There was no difference found in the postoperative pain level, length of hospital-stay and pain level 1 year after surgery. Biochemical cancer-free survival was highly related to TNM stage (p < 0.001, pT3 vs. pT2 hazard ratio 5.4 [95%CI 3.3; 9.2]) but not to the type of anaesthesia (p = 0.29).ConclusionsSpinal anaesthesia preceding general anaesthesia for RRP is associated with increased postoperative opioid consumption compared to general anaesthesia alone. Postoperative pain level and the oncological outcome are not affected by the adjunctive use of spinal anaesthesia. Thus, the addition of spinal anaesthesia to general anaesthesia has no advantage in RRP.Trial registrationClinicalTrial.gov, NCT03565705.

Dataset Information

Use of a specific questionnaire and perineal electromyography to assess neuropathic pain after radical retropubic prostatectomy.

Publications

Use of a specific questionnaire and perineal electromyography to assess neuropathic pain after radical retropubic prostatectomy.

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