Anatomic approach for placement of surgical drains after radical retropubic prostatectomy: Long-term effects on postoperative pain

Objectives. The placement of drains following radical retropubic prostatectomy (RRP) may potentially damage neural and vascular structures within the abdominal wall, leading to postoperative pain and morbidity. In this study, we compare postoperative pain in two groups of men who underwent RRP. The Davol drains were either placed lateral to the rectus muscle (n = 100) or in the medial two thirds of the rectus muscle (n = 100). Methods. We investigated postoperative pain for an average of 5 months after RRP. Detailed responses were obtained from 89.5% (179 of 200) of the men. The average age was 57 years and the average follow-up 20 weeks. Results. Overall, 33.5% (60 of 179) of the men reported postoperative pain associated with either the incision or drain site. Rated on a scale of 0 to 10 (with 10 representing the most pain), the average pain scale assessment was 1.3 ± 2.6 (range 0 to 6). Pain was attributable to the incision site only in 9% (16 of 179) and at the drain site only in 24% (42 of 179). We found more pain overall (41%) where the drains were placed lateral to the rectus muscle as compared with men in whom the drains were placed in the medial two thirds of the rectus muscle (26%) (P = 0.03). Conclusions. Placement of drains in the medial two thirds of the rectus muscles avoids injury to intercostal nerves and results in less pain at the drain sites.