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To the Editor.—The article by Dr Gottschalk and colleagues¹ is misleading and not clinically relevant and represents neither optimal care nor standard of care in prostate cancer patients undergoing radical prostatectomy. Their hypothesis concerning the value of preemptive analgesia and the study design to test this question may be appropriate in many clinical settings but not for radical prostatectomy. The use of epidural analgesia is neither cost-effective nor necessary to provide excellent postoperative pain control after this procedure.

Quality of care and cost-effectiveness of radical prostatectomy have received substantial attention in the urologic literature. Many centers have developed and described clinical care pathways outlining such care.^2-4 Our experience with a clinical care pathway similar to those reported demonstrates that intravenous ketorolac administered at the time of fascial closure and continued every 6 hours provides excellent pain control. Patients are routinely out of bed the day of surgery, start drinking . . . [Full Text of this Article]

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