{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T21:44:55Z","timestamp":1774129495857,"version":"3.50.1"},"reference-count":35,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Robotic hysterectomy and Enhanced Recovery After Surgery (ERAS) are two significant improvements in gynecologic surgery, both associated with decreased postoperative pain and faster recovery. Spinal analgesia guarantees excellent pain coverage; however, its appropriateness in robotic procedures is still controversial. The aim of the study was to compare postoperative pain control after robotic hysterectomy in patients receiving spinal analgesia versus intravenous low-dose oxycodone. Methods: Consecutive patients undergoing robotic hysterectomy from January 2022 to July 2023 were included in the analysis. Until August 2022, patients received spinal analgesia, while from September 2022, low-dose oxycodone was administered intraoperatively. All patients were managed following the ERAS protocol. Primary outcomes were the VAS pain score and opioid rescue use, while secondary outcomes included postoperative nausea and vomiting (PONV), mobilization, oral intake, and length of hospital stay (LOS). Results: Of 114 patients, 67 (58.8%) received spinal analgesia and 47 (41.2%) received intravenous low-dose oxycodone. No differences were reported in the VAS pain score at day 0 (1.5 \u00b1 1.6 vs. 1.6 \u00b1 2.2, p = 0.78) and day 1 (2.0 \u00b1 2.1 vs. 1.3 \u00b1 1.8, p = 0.07). At day 2, the VAS pain score was 1.4 \u00b1 1.6 in the spinal analgesia group and 0.7 \u00b1 1.0 in the oxycodone group (p = 0.01). No differences were reported in the need for opioid rescue at days 1 and 2 (p = 1.00). At day 0, 26 patients (38.8%) experienced PONV in the spinal analgesia group versus 8 (17.0%) in the oxycodone group (p = 0.01). Conclusions: Patients receiving intraoperative low-dose oxycodone experienced comparable satisfactory postoperative pain control with a lower incidence of PONV when compared to the spinal analgesia group.<\/jats:p>","DOI":"10.3390\/jcm14196957","type":"journal-article","created":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T11:06:02Z","timestamp":1759316762000},"page":"6957","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Spinal Analgesia Versus Intravenous Low-Dose Oxycodone for Pain Management After Robotic Hysterectomy: Preliminary Results from an ERAS Institution"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6990-7100","authenticated-orcid":false,"given":"Elisa","family":"Peano","sequence":"first","affiliation":[{"name":"Department of Gynecology and Obstetrics, Azienda Sanitaria Ospedaliera S. Croce e Carle, 12100 Cuneo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberta","family":"Rosso","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Azienda Sanitaria Ospedaliera S. Croce e Carle, 12100 Cuneo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katia","family":"Audisio","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, University of Turin, 10124 Torino, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Coletta","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Azienda Sanitaria Ospedaliera S. Croce e Carle, 12100 Cuneo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1714-7765","authenticated-orcid":false,"given":"Andrea","family":"Puppo","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Azienda Sanitaria Ospedaliera S. Croce e Carle, 12100 Cuneo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barbara","family":"Franzoso","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Azienda Sanitaria Ospedaliera S. Croce e Carle, 12100 Cuneo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1177\/15533506241238038","article-title":"Robot Assisted Laparoscopic Surgery in Gynaecology: An Evolving Assistive Technology","volume":"3","author":"Xie","year":"2024","journal-title":"Surg. Innov."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1016\/j.jmig.2020.12.023","article-title":"Minimally Invasive Radical Hysterectomy for Cervical Cancer: A Systematic Review and Meta-analysis","volume":"28","author":"Smith","year":"2021","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/j.ogc.2022.02.009","article-title":"Role of Robotic Surgery in Benign Gynecology","volume":"49","author":"Truong","year":"2022","journal-title":"Obstet. Gynecol. Clin. N. Am."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1080\/13645706.2021.2010763","article-title":"Robotic surgery in gynecology: Is the future already here?","volume":"31","author":"Gitas","year":"2022","journal-title":"Minim. Invasive Ther. Allied Technol."},{"key":"ref_5","first-page":"423","article-title":"Robotic versus laparoscopic surgery in gynecology: Which should we use?","volume":"68","author":"Fanfani","year":"2016","journal-title":"Minerva Ginecol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1007\/s13224-023-01852-x","article-title":"Robotic Surgery in Gynaecology: A Retrospective Evaluation of an Experience at a Single Centre","volume":"74","author":"Kurup","year":"2024","journal-title":"J. Obstet. Gynaecol. India"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e588","DOI":"10.1097\/PR9.0000000000000588","article-title":"Postoperative pain-from mechanisms to treatment","volume":"2","author":"Segelcke","year":"2017","journal-title":"Pain Rep."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1080\/08998280.2000.11927683","article-title":"Acute postoperative pain management","volume":"13","author":"Ramsay","year":"2000","journal-title":"Proc. Bayl. Univ. Med. Cent."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2321","DOI":"10.1007\/s11605-009-0927-2","article-title":"Enhanced recovery after surgery (ERAS) programs for patients having colorectal surgery: A meta-analysis of randomized trials","volume":"13","author":"Eskicioglu","year":"2009","journal-title":"J. Gastrointest. Surg. Off. J. Soc. Surg. Aliment. Tract."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1097\/SLA.0000000000002632","article-title":"Postoperative ERAS Interventions Have the Greatest Impact on Optimal Recovery: Experience with Implementation of ERAS Across Multiple Hospitals","volume":"267","author":"Aarts","year":"2018","journal-title":"Ann. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1055\/s-0038-1676477","article-title":"Pain Management in Enhanced Recovery after Surgery (ERAS) Protocols","volume":"32","author":"Simpson","year":"2019","journal-title":"Clin. Colon Rectal Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.anclin.2014.11.011","article-title":"Evidence-based anesthesia for major gynecologic surgery","volume":"33","author":"Bauchat","year":"2015","journal-title":"Anesthesiol. Clin."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.jmig.2020.08.006","article-title":"Enhanced Recovery and Surgical Optimization Protocol for Minimally Invasive Gynecologic Surgery: An AAGL White Paper","volume":"28","author":"Stone","year":"2021","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"382.e1","DOI":"10.1016\/j.ajog.2012.09.014","article-title":"Feasibility and economic impact of same-day discharge for women who undergo laparoscopic hysterectomy","volume":"207","author":"Ananth","year":"2012","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1016\/j.ajog.2016.12.175","article-title":"Non-opioid pain management in benign minimally invasive hysterectomy: A systematic review","volume":"216","author":"Blanton","year":"2017","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e2023.00050","DOI":"10.4293\/JSLS.2023.00050","article-title":"Spinal Anesthesia Prior to Laparoscopic Hysterectomy Resulted in Decreased Postoperative Pain and Opioid Use","volume":"27","author":"Warta","year":"2023","journal-title":"J. Soc. Laparosc. Robot. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1001\/jamasurg.2016.4952","article-title":"Enhanced Recovery After Surgery: A Review","volume":"152","author":"Ljungqvist","year":"2017","journal-title":"JAMA Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1111\/j.1365-2044.2008.05817.x","article-title":"Risks and side-effects of intrathecal morphine combined with spinal anaesthesia: A meta-analysis","volume":"64","author":"Gehling","year":"2009","journal-title":"Anaesthesia"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1097\/ACO.0000000000001063","article-title":"Management of postoperative nausea and vomiting in adults: Current controversies","volume":"34","author":"Rajan","year":"2021","journal-title":"Curr. Opin. Anaesthesiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.23736\/S0375-9393.19.13136-7","article-title":"A preoperative single dose of methadone for moderate-to-severely painful surgery reduces postoperative morphine consumption","volume":"85","author":"Bastian","year":"2019","journal-title":"Minerva Anestesiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1185\/030079908X253708","article-title":"Oxycodone: A review of its use in the management of pain","volume":"24","author":"Riley","year":"2008","journal-title":"Curr. Med. Res. Opin."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1224","DOI":"10.1001\/jamasurg.2014.210","article-title":"Analgesia After Open Abdominal Surgery in the Setting of Enhanced Recovery Surgery: A Systematic Review and Meta-analysis","volume":"149","author":"Hughes","year":"2014","journal-title":"JAMA Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1276","DOI":"10.1016\/S0140-6736(02)08266-1","article-title":"Epidural anaesthesia and analgesia and outcome of major surgery: A randomised trial","volume":"359","author":"Rigg","year":"2002","journal-title":"Lancet Lond. Engl."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.ygyno.2018.08.015","article-title":"Celecoxib versus ketorolac following robotic hysterectomy for the management of postoperative pain: An open-label randomized control trial","volume":"151","author":"Ulm","year":"2018","journal-title":"Gynecol. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1136\/ijgc-2020-001339","article-title":"Postoperative complications of epidural analgesia at hysterectomy for gynecologic malignancies: An analysis of the National Surgical Quality Improvement Program","volume":"30","author":"Ackroyd","year":"2020","journal-title":"Int. J. Gynecol. Cancer Off. J. Int. Gynecol. Cancer Soc."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1002\/bjs.8972","article-title":"Robotic cancer surgery","volume":"100","author":"Sodergren","year":"2013","journal-title":"Br. J. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"79","DOI":"10.4103\/joacp.JOACP_354_18","article-title":"Comparison of analgesic requirements in robot-assisted versus conventional laparoscopic abdominal surgeries","volume":"37","author":"Mangalath","year":"2021","journal-title":"J. Anaesthesiol. Clin. Pharmacol."},{"key":"ref_28","first-page":"593","article-title":"Evaluation of lignocaine, dexmedetomidine, lignocaine-dexmedetomidine infusion on pain and quality of recovery for robotic abdominal hysterectomy: A prospective randomized controlled trial","volume":"72","author":"Sivaji","year":"2022","journal-title":"Braz. J. Anesthesiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"928","DOI":"10.1111\/aas.12516","article-title":"Transversus abdominis plane (TAP) block after robot-assisted laparoscopic hysterectomy: A randomised clinical trial","volume":"59","author":"Torup","year":"2015","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1093\/bja\/76.3.358","article-title":"Influence of dose and timing of administration of morphine on postoperative pain and analgesic requirements","volume":"76","author":"Mansfield","year":"1996","journal-title":"Br. J. Anaesth."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.ijoa.2012.10.007","article-title":"Efficacy and safety of intraoperative intravenous methadone during general anaesthesia for caesarean delivery: A retrospective case-control study","volume":"22","author":"Russell","year":"2013","journal-title":"Int. J. Obstet. Anesth."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1213\/ANE.0b013e3181d8a095","article-title":"Intraoperative methadone improves postoperative pain control in patients undergoing complex spine surgery","volume":"112","author":"Gottschalk","year":"2011","journal-title":"Anesth. Analg."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Jim\u00e9nez Cruz, J., Kather, A., Nicolaus, K., Rengsberge, M., Mothes, A.R., Schleussner, E., Meissner, W., and Runnebaum, I.B. (2021). Acute postoperative pain in 23 procedures of gynaecological surgery analysed in a prospective open registry study on risk factors and consequences for the patient. Sci. Rep., 11.","DOI":"10.1038\/s41598-021-01597-5"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1097\/01.sla.0000193806.81428.6f","article-title":"Laparoscopic surgery may be associated with severe pain and high analgesia requirements in the immediate postoperative period","volume":"243","author":"Ekstein","year":"2006","journal-title":"Ann. Surg."},{"key":"ref_35","first-page":"71","article-title":"Evaluation of post operative shoulder tip pain in low pressure versus standard pressure pneumoperitoneum during laparoscopic cholecystectomy","volume":"10","author":"Yasir","year":"2012","journal-title":"Surg. J. R. Coll. Surg. Edinb. Irel."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/19\/6957\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T11:23:32Z","timestamp":1759317812000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/19\/6957"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,1]]},"references-count":35,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["jcm14196957"],"URL":"https:\/\/doi.org\/10.3390\/jcm14196957","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,1]]}}}