Anesthetic Care Plan for Robotic Gynecologic Cancer Surgery

Preoperative Analgesia

The American College of Surgeons recommends administering paracetamol and NSAIDs preoperatively to reduce postoperative pain scores and opioid consumption, with a strength of evidence level I 1, 2
The American Society of Anesthesiologists suggests that gabapentin, given as a single preoperative dose, reduces postoperative pain scores and opioid consumption, with a moderate level of evidence 2
Dexamethasone provides analgesic benefits and reduces postoperative nausea/vomiting when given as a single intravenous dose, according to the American Society of Anesthesiologists, with a high level of evidence 2

The American Society of Regional Anesthesia and Pain Medicine recommends bilateral Transversus Abdominis Plane (TAP) block as the first-choice regional technique for robotic gynecologic surgery, with a high level of evidence 1, 4
Bilateral TAP block has demonstrated lower pain scores, reduced opioid consumption, and minimal invasiveness compared to neuraxial techniques, according to the American Society of Regional Anesthesia and Pain Medicine, with a moderate to high level of evidence 1, 4

The American Society of Anesthesiologists recommends using short-acting anesthetics to facilitate rapid emergence, with a high level of evidence 6
Either volatile-based or total intravenous anesthesia (TIVA) is acceptable, according to the American Society of Anesthesiologists, with a moderate level of evidence 5
The American Society of Anesthesiologists suggests avoiding nitrous oxide due to increased nausea and vomiting, with a high level of evidence 6
Monitoring neuromuscular blockade depth and ensuring complete reversal before extubation is crucial, according to the American Society of Anesthesiologists, with a high level of evidence 6

The American College of Obstetricians and Gynecologists recommends administering intravenous antibiotics within 60 minutes before incision, with a high level of evidence 6

The American Pain Society recommends continuing scheduled multimodal analgesia with paracetamol and NSAIDs/COX-2 inhibitors, with a high level of evidence 1, 2
Opioids should be reserved strictly as rescue medication when non-opioid analgesics fail to provide adequate control, according to the American Pain Society, with a high level of evidence 1, 2
Minimizing home-going opioid prescriptions is essential, according to the American College of Surgeons, with a moderate to high level of evidence 6

Failing to administer basic analgesics optimally is the most common error, occurring in 90% of cases, according to the American Society of Anesthesiologists, with a moderate level of evidence 3
Using opioids as primary analgesic rather than a multimodal approach is not recommended, according to the American Pain Society, with a high level of evidence 1, 3