Introduction: Robot-assisted radical prostatectomy (RARP) is associated with improved postoperative pain control and reduced opioid requirements compared with open surgery. Recent literature has shown a decreased need for narcotic use in the post-operative period. However, there is still question over the optimal pain regimen. Our study evaluates a non-narcotic regimen for patients undergoing RARP that centers on preoperative erector spinae plane (ESP) blocks. Methods: In association with the Department of Anesthesiology, a non-narcotic analgesic pathway was created for patients undergoing RARPs. The pathway was centered on an ESP block and replacing narcotics with multi-modal analgesia post-operatively. After IRB approval, a retrospective cohort of patients who received narcotics post-operatively and no ESP block pre-operatively was compared to a prospective cohort of patients who underwent the non-narcotic pathway. Narcotics were available for patients in the non-narcotic group if their pain was not controlled. Patients were excluded from the non-narcotic group if NSAIDs were contraindicated, if they were taking narcotics, or if they underwent a concomitant procedure at the time of RARP. Nursing pain scores were recorded for each patient, as well as post-operative morphine equivalents received, if narcotic was prescribed for home, the amount of morphine equivalents prescribed for home, and the need for any narcotic refills. Results: 163 patients were in the narcotic group compared to 131 in the non-narcotic group. There was a statistically significant difference in average post-operative pain scores between the narcotic and non-narcotic groups (3.5 vs. 2.4, p<0.001) and a statistically significant difference in postoperative morphine equivalents delivered (49.4 vs. 7.4, p<0.001). In addition, only 17 patients in the non-narcotic group were discharged with a narcotic prescription for home, compared to 161 in the narcotic cohort (13.0% vs, 98.8%, p<0.001). The average length of stay was lower in the non-narcotic group (1.1 vs 1.3, p<0.001). No adverse patient events resulted from the block. Conclusions: A non-narcotic analgesic pathway centered on pre-operative ESP blocks decreased both post-operative pain scores and post-operative morphine equivalents received in patients who underwent RARP, providing an additional modality to aid in optimal, non-narcotic analgesia. SOURCE OF Funding: N/a
