Introduction: Postoperative nausea and vomiting (PONV) and pain are common adverse events after laparoscopic surgery. Perioperative dexamethasone (8-10mg) has been reported to decrease PONV and pain in other laparoscopic procedures such as hysterectomy and cholecystectomy. We hypothesized that dexamethasone would also be effective for laparoscopic donor nephrectomy (LDN).

Patients and Methods: We performed a retrospective cohort study of 211 living donors who underwent LDN between February 2013 and October 2015. All nephrectomies were done using the intraperitoneal pure LDN approach by three experienced surgeons. Local anesthesia was injected into the wounds at the end of the LDN and patient-controlled analgesia was used for the first 24hrs after LDN. Total fentanyl and hydromorphone injections were converted into oral morphine equianalgesic dose. One hundred dexamethasone (DEX, 8-14mg) injected donors were compared with 111 controls with analysis of the outcomes and incidences of PONV and pain within 24hrs after LDN.

Results: DEX significantly reduced overall PONV incidence (64.9% in control and 47.0% in DEX, respectively. p=0.009) and severity (defined as PONV >3 times, 23.4% in control and 10.0% in DEX, respectively. p=0.0096). PONV was continuously suppressed in both early (<6hrs) and late phase (6-24hrs) with DEX (<6hrs; p=0.015 and 6-24hrs; p=0.03). Total intravenous opioid use in the first 24hrs was significantly lower in DEX compared to control (39.8+/-36.6 mg in control and 29.0+/-35.9 mg in DEX, respectively. p=0.009). Postoperative complication rates and postoperative hospital stays were not different between the groups. Propensity score matching on American Society of Anesthesiologists score, age, sex, body mass index and operative time slightly increased the differences between the groups. Notably, ketorolac given intraoperatively and continued for 24 hours did not appear to decrease PONV or narcotic usage.

Conclusions: A single perioperative injection of 8-10mg dose dexamethasone decreases antiemetic and narcotic requirements in the first 24hrs, with no increase in surgical complication. This translates into improved donor comfort and potentially improved safety through fewer surgical complications associated with narcotic use.

CITATION INFORMATION: Yamanaga S, Posselt A, Freise C, Kang S.-M. Improving Donor Comfort: Perioperative Dexamethasone Decreases Nausea, Vomiting, and Pain After Laparoscopic Donor Nephrectomy. Am J Transplant. 2016;16 (suppl 3).

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