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

INTERVENTION: Group SUB: Subarachnoid analgesia (administered once only immediately before the general anesthesia) using 10.5 mg ropivacaine 0.75%, 30 mcg clonidine150 mcg/mL, 2 mcg/Kg morphine 100 mcg/mL and 0.03 mcg/Kg sufentanil 5 mcg/mL with a sterile 27 G needle at the L1‐L2 or L2‐L3 interspace. Thirty minutes before the end of the surgery, patients will be treated with a single intravenous bolus only of 1g of paracetmol and 30mg of ketorolac and a continuous intravenous infusion of 45 mg/day ketorolac and 1 mcg/Kg/day clonidine started immediately after the bolus of paracetamol and ketorolac and administered over the 48 hour postoperative period. We will monitor the adherence to the intervention through audit of medication charts. Group ESP: before the general anesthesia, patients will undergo bilateral ultrasound‐guided in‐plane erector spinae plane (ESP) block performed once only per side, placing the needle between the erector spinae muscle and the transverse process of the T10 or T11 vertebra and injecting, for each side, 30 mcg clonidine, 4 mg dexamethasone, 100 mg ropivacaine (total volume 20 ml). In these patients a single intravenous bolus only of 1g of paracetamol and 30mg of ketorolac was given 30 minutes before the end of the surgery and a continuous intravenous infusion with 45 mg/day ketorolac and 1 mcg/Kg/day clonidine, starting immediately after the bolus of paracetamol and ketorolac, was administered over the 48 hour postoperative period. We will monitor the adherence to the intervention through audit of medication charts. CONDITION: Anaesthesiology ‐ Pain management Cancer ‐ Prostate Postoperative pain after robot‐assisted radical prostatectomy;Prostate cancer; ; Postoperative pain after robot‐assisted radical prostatectomy ; Prostate cancer Surgery ‐ Other surgery PRIMARY OUTCOME: Pain measured with numeric rating scale (NRS).[Every 15 minutes for the first hour postoperatively, and at 3, 6, 12 (primary endpoint), 24, and 48 hours post‐surgery.] SECONDARY OUTCOME: Bladder spasm assessed by a patient self reported 5 Likert scale: 1‐no spasm; 2‐mild; 3‐moderate; 4‐ severe; 5‐ intolerable.[12 hours post‐surgery] Intraoperative opioids consumption evaluated by accessing medication charts.[End of the surgery] Patient satisfaction assessed by a 5‐point Likert scale: 1‐not at all satisfied; 2‐ poorly; 3‐ moderately satisfied; 4‐satisfied; 5‐very satisfied.[3, 6, 12, 24, 48 hours after surgery] Time between the end of surgery and the request for the first additional dose of analgesic determined by accessing medication charts[First 48 hours after surgery] Time to mobilization assessed by accessing nursing notes[First 48 hours after surgery] INCLUSION CRITERIA: Age greater than or equal to 18 years; American Society of Anesthesiologists (ASA) physical status I‐III; Body Mass Inde X(BMI) < 35 kg/m2; diagnosis of prostate cancer.