Comparison of intra- and postoperative analgesia and pain perception in robot-assisted vs. open radical prostatectomy

  • Sophie KnipperEmail author
  • Moritz Hagedorn
  • Maryam Sadat-Khonsari
  • Zhe Tian
  • Pierre I. Karakiewicz
  • Derya Tilki
  • Hans Heinzer
  • Uwe Michl
  • Thomas Steuber
  • Franziska von Breunig
  • Christian Zöllner
  • Markus Graefen
Original Article



One of the advantages of minimally invasive surgery may be reduced postoperative pain and faster recovery. However, reliable comparisons of robot-assisted (RARP) vs. open radical prostatectomy (ORP) addressing perioperative pain regimen are scarce.


We identified 420 consecutive treated patients who underwent RARP (n = 254) vs. ORP (n = 166) for clinically localized prostate cancer in 2017. After 1:1 propensity score matching for age, body mass index, D’Amico risk classification and lymph node yield, intra- and postoperative pain medication doses, as well as pain perception expressed by the numeric rating scale were assessed in uni- and multivariable analyses.


Median age was 64.9 years. Operation time was significantly shorter in ORP patients (155 vs. 175 min in RARP, p < 0.001). Overall, a median of 12.5 vs. 12 g of metamizol was administered in RARP vs. ORP patients (p = 0.2). Additionally, a median of 146.7 vs. 133.9 mg of morphine equivalent was administered in RARP vs. ORP patients (p < 0.001). The mean maximum pain perceived on day 0 was 3.2 vs. 3.6 in RARP vs. ORP patients (p = 0.1). It decreased within the following days, and again, no differences between the two groups were observed. All results were confirmed in multivariable analyses.


When comparing RARP vs. ORP, a small increase in perioperative morphine administration at RARP may be expected. However, when assessing pain perception, no differences were observed between the two groups. Moreover, mean maximum pain perceived was very low, which may reassure patients, who are counselled for radical prostatectomy.


Prostate cancer Morphine equivalent Numeric rating scale Perioperative pain 


Author contributions

Protocol/project development: MG, SK. Data collection or management: MH, SK, MS-K. Data analysis: SK, ZT. Manuscript writing/editing: all authors

Compliance with ethical standards

Conflict of interest

There was no external financial support for this study. The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

This article does not contain any studies with human participants performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Sophie Knipper
    • 1
    • 2
    Email author
  • Moritz Hagedorn
    • 3
  • Maryam Sadat-Khonsari
    • 4
  • Zhe Tian
    • 2
  • Pierre I. Karakiewicz
    • 2
  • Derya Tilki
    • 1
    • 4
  • Hans Heinzer
    • 1
  • Uwe Michl
    • 1
  • Thomas Steuber
    • 1
  • Franziska von Breunig
    • 5
  • Christian Zöllner
    • 5
  • Markus Graefen
    • 1
  1. 1.Martini-Klinik Prostate Cancer CenterUniversity Hospital Hamburg-EppendorfHamburgGermany
  2. 2.Cancer Prognostics and Health Outcomes Unit, Division of UrologyUniversity of Montreal Health CenterMontrealCanada
  3. 3.Department of AnesthesiologyAsklepios Klinik BarmbekHamburgGermany
  4. 4.Department of UrologyUniversity Hospital Hamburg-EppendorfHamburgGermany
  5. 5.Department of AnesthesiologyUniversity Hospital Hamburg-EppendorfHamburgGermany

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