Obese Kidney Donors: Impact of Opioid-Minimization Using Ketorolac-Based Pain Management Protocol Following Robotically Assisted, Laparoscopic Living Donor Nephrectomy.

M. Campara, B. Valdepenas, A. Virani, K. Galen, I. Tang, J. Oberholzer, E. Benedetti.

University of Illinois Hospital, Chicago

Meeting: 2017 American Transplant Congress

Abstract number: C86

Keywords: Donation, Length of stay, Pain

Session Information

Session Name: Poster Session C: Donor Management: All Organs

Session Type: Poster Session

Date: Monday, May 1, 2017

Session Time: 6:00pm-7:00pm

Presentation Time: 6:00pm-7:00pm

Location: Hall D1

INTRODUCTION: Obese have been excluded from living donor pool due to risk of surgical complications. Advances in robotic techniques minimized complications and increased use of obese as kidney donors. This study aims to compare outcomes of ketorolac-based pain protocol against opioid-based regimen in this patient population.

METHODS: Single-center, retrospective study of obese, adult donors who underwent robot-assisted, laparoscopic nephrectomy from 2010 to 2015. Adults with BMI >=30 kg/m² were included in analysis. Ketorolac protocol was implemented in April 2014 and includes scheduled ketorolac 15 mg IVP q6h with APAP 500 mg PO q6h. Per protocol, patients may receive 15 mg of ketorolac IVP q6h PRN breakthrough pain, tramadol 50 mg PO q6h PRN moderate pain and APAP/hydrocodone 5/325 mg PO q6h PRN moderate-high pain. Prior to ketorolac protocol, opioid analgesia was ordered per surgical resident. Primary outcome was length of hospitalization. Secondary outcomes included opioid exposure in morphine equivalents/day and 1-month estimated glomerular filtration rate (eGFR). Chi-square and T-test were used as appropriate with the alpha value set at 0.05.

RESULTS: Out of 159 obese donors; 50 (31%) received ketorolac-based analgesia postoperatively. There was no difference in age, gender or race between groups. Ketorolac group had greater BMI (36.8±4.5 kg/m2 vs. 34.7±4.2 kg/m2, p=0.01). Average length of stay was 2.9±0.82 days in ketorolac group vs. 3.0±0.9 days in opioid cohort (p=0.53). Overall opioid exposure was 15.3±12.8 mg/day in ketorolac group vs. 23.7±16.6 mg/day (p=0.002). The 1-month eGFR was 62.3±13.9 mL/min in ketorolac cohort vs. 54.6±14.5 mL/min (p = 0.006) for opioid regimen.

CONCLUSION: Ketorolac based analgesia did not decrease length of stay in obese patients following kidney donation. However, there was a significant reduction in use of opioids without negative impact on eGFR 1-month following kidney donation.

	Ketorolac n=50	Opioid n=109	p-value
Age (years), mean±SD	36.5±10	37.9±10
Male, %	46	49.5
African American, %	52	43
Caucasian, %	20	24.8
Hispanic, %	24	32.1
BMI (kg/m²), mean±SD	36.8±4.5	34.7±4.2	<0.05
Pre-donation GFR (ml/min/1.73m²), mean±SD	97.8±18.4	90.4±22.6	<0.05

CITATION INFORMATION: Campara M, Valdepenas B, Virani A, Galen K, Tang I, Oberholzer J, Benedetti E. Obese Kidney Donors: Impact of Opioid-Minimization Using Ketorolac-Based Pain Management Protocol Following Robotically Assisted, Laparoscopic Living Donor Nephrectomy. Am J Transplant. 2017;17 (suppl 3).

To cite this abstract in AMA style:

Campara M, Valdepenas B, Virani A, Galen K, Tang I, Oberholzer J, Benedetti E. Obese Kidney Donors: Impact of Opioid-Minimization Using Ketorolac-Based Pain Management Protocol Following Robotically Assisted, Laparoscopic Living Donor Nephrectomy. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/obese-kidney-donors-impact-of-opioid-minimization-using-ketorolac-based-pain-management-protocol-following-robotically-assisted-laparoscopic-living-donor-nephrectomy/. Accessed November 22, 2024.

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