The Relationship Between Intraoperative ETCO2 Levels and Postoperative Pain and Nausea-Vomiting

Study Overview
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Brief Summary
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The aim of our study is to investigate the relationship between intraoperative ETCO2 levels and postoperative nausea-vomiting and pain scores in patients undergoing robotic laparoscopic radical prostatectomy. The investigators will monitor patients' 24-hour postoperative pain, nausea-vomiting and the consumption of additional analgesic and antiemetic medications.

Detailed Description
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Robotic surgery provides several advantages in the field of surgery, including a three-dimensional view of the surgical site, the elimination of surgeon hand tremors, and enhanced precision in movements. Additionally, it offers benefits such as reduced intraoperative bleeding, faster return to daily functions for patients, and decreased hospitalization duration. Consequently, the use of robots in various surgical procedures has become widespread in contemporary medical practice. Robot-assisted laparoscopic radical prostatectomy is a surgical technique performed in a head-down Trendelenburg position with intraperitoneal insufflation of carbon dioxide (CO2). This positioning and pneumoperitoneum lead to an increase in intraabdominal pressure, as well as elevated intracranial and intraocular pressures. End-tidal carbon dioxide (ETCO2) levels can vary during laparoscopic surgery. An increase in ETCO2 levels has been reported to cause an elevation in intracranial pressure, leading to an increased incidence of postoperative nausea and vomiting. Some studies in the literature have investigated the relationship between ETCO2 values and the incidence of postoperative nausea and vomiting in patients. Furthermore, it is believed that hypercarbia (elevated carbon dioxide levels) may have an impact on postoperative pain. The aim of our study is to investigate the relationship between intraoperative ETCO2 levels and postoperative nausea, vomiting, and pain scores in patients undergoing robotic laparoscopic radical prostatectomy. The investigators will monitor patients' 24-hour postoperative pain, nausea, vomiting, and the consumption of additional analgesic and antiemetic medications.

Official Title
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The Relationship Between Intraoperative ETCO2 Levels and Postoperative Pain and Nausea-Vomiting in Laparoscopic Robotic Prostatectomy Patients

Conditions
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Pain, Postoperative, Nausea, Postoperative, Vomiting, Postoperative

Intervention / Treatment
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* Other: ETCO2 levels
* Other: Patients with high ETCO2 levels


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Individuals between the ages of 18 and 80. Patients with American Society of Anesthesiologists (ASA) scores I, II, or III. Patients who have undergone robotic laparoscopic prostatectomy in the operating room. Exclusion Criteria: Patients under 18 years old or over 80 years old. Patients with American Society of Anesthesiologists (ASA) scores IV and above. Patients who refuse to participate in the study. Patients undergoing emergency surgery.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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Male

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Patients with low ETCO2 levels<br>Intraoperative ETCO2 values between 26 and 34 in laparoscopic robotic prostatectomy patients were included in this group. | Other: ETCO2 levels<br>* Intraoperative ETCO2 values between 26 and 34 in laparoscopic robotic prostatectomy patients were included in group 1.<br>* Other names: Patients with low ETCO2 levels;|
| Patients with high ETCO2 levels<br>Intraoperative ETCO2 values between 35 and 45 in laparoscopic robotic prostatectomy patients were included in this group. | Other: Patients with high ETCO2 levels<br>* Intraoperative ETCO2 values between 35 and 45 in laparoscopic robotic prostatectomy patients were included in group 2.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Postoperative nausea and vomiting (PONV) Score | Postoperative nausea and vomiting recording in patients. 0=no PONV: patient reports no nausea and has had no emesis episodes; 1=mild PONV: patient reports nausea but declines antiemetic treatment; 2=moderate PONV: patient reports nausea and accepts antiemetic treatment; and 3=severe PONV: nausea with any emesis episode (retching or vomiting). Higher scores indicate severe postoperative nausea and vomitting. | 0-2-4-8-12-24 hours postoperatively | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain on the Numeric Rating Scale (NRS) | Participants recorded pain rated on the numeric rating scale (NRS) at 6 time points. NRS range was from 0-10 with 0 being no pain and 10 the worst pain possible. | 0-2-4-8-12-24 hours postoperatively | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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End-tidal carbon dioxide, Laparoscopic Robotic Prostatectomy