Background:

Enhanced recovery after surgery protocol has proven its efficacy in many surgery fields in controlling pain and promoting early recovery . The implication of the ERASprotocol in living donor liver patients is a new step to enhance early recovery for the donors. The Aim of this study to evaluate the living liver donors after implication of the ERAS protocol and compare it with the group of donors who were previously managed without the ERAS and see if It makes any difference is recovery .

Methods:

2 groups of living liver donors Group A is the living donor patients who had the ERAS protocol applied and group B which is the group of donors who had their surgery done before application of the ERAS protocol. Different types of Protocol were described in different literatures which all gave comparable results. Our protocol starts intraoperatively through intrathecal injection of morphine and also injection of long acting Marcain in the muscle layers . Postoperatively the patients receive 2 days of Ketamine infusion followed by 2 days of Lidocain infusion with scheduled Ketorlac IV for the first 48 hrs postoperative. There is also PRN hydromorphone. The Main goal of this protocol is to provide adequate and efficient pain control with minimal opioid use which will promote early bowel function and minimize hospital stay.

Results:

During the last 3 years 91 living liver donors were done at UPMC for both adults and pediatric cases. All the donors had the same abdominal incision .The ERAS protocol was applied on the last 11 cases which showed early satisfactory results . It showed that the pain in postoperative day 1 and 2 is minimal with early bowel function which was 1.76 days compared to the 3.4 days in the control group and P value 0.003 (graph 1). Also the patients were able to tolerate regular diet, the ERAS group patients were able to tolerate regular diet within 2.9 days in comparison to 6.1 to the control group with P value 0.0057 (graph 2). Finally hospital stay was significantly lower to 4.9 days compared to 7.9 dyas with P value 0.186.

Conclusions:

ERAS protocol proved its effectiveness in minimizing post operative pain and decreases the use of postoperative narcotics which helps early recovery and decreases hospital stay which minimizes hospital coast.

CITATION INFORMATION: Khalil A, Ganesh S, Hughes C, Tevar A, Hatche J, Esper S, Humar A. Evaluation of the Enhanced Recovery After Surgery Protocol in Living Liver Donors. Am J Transplant. 2017;17 (suppl 3).

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