Opioid exposure is a concern after live donation (LD) for transplant. We theorized that a protocol using pregablin pre-operation to desensitize nerves followed by ketorolac after surgery can control pain thus requiring less perioperative narcotics. The aim was to determine a non-opioid analgesics protocol for LD nephrectomies could decrease the use of narcotics without an increase in complications compared to standard of care (SOC).

Methods

This was a single center, prospective, double blind, randomized trial involving 62 patients undergoing nephrectomy for LD transplantation during 9/16-9/17. Patients were randomized by the University of Utah Investigational pharmacy (Table 1) SOC included intra/post-operative narcotics that were controlled. Patients were followed during the hospital stay. Outcomes were bleeding, 30 day mortality, renal function, narcotic use, length of hospital stay (LOS), and urinary retention. The Washington State Agency Medical Director's Group Opioid dose calculator was used to provide a total morphine dose equivalent (MDE). Data were analyzed using R 3.4.1 using a t, exact Wilcoxon rank sum, chi-squared, or Fisher's exact test. The hospital cost of this protocol was <$10/patient.

Results

(Table 1) LOS was significantly reduced by 10% in the study group versus the SOC+placebo group. MDE were significantly reduced by 40% the study group versus the SOC+placebo group.There were no patient deaths, blood transfusions or renal dysfunction in either study Arm.

Conclusion

Opioid addiction and cost of care are important concerns in surgery. The use of this non-opioid analgesics protocol for LD nephrectomies decreased the use of narcotics without an increase in complications compared to SOC. There was significantly reduced LOS and less narcotic use in the study group versus the SOC+placebo group. The protocol was <$10/patient and LOS was significantly decreased. This protocol may decrease cost for LD nephrectomies.

CITATION INFORMATION: Campsen J., Call T., Rosales A., Allen C., Presson A., Kim R. Prospective, Double Blind, Randomized Trial Comparing the Use of Ketorolac and Lyrica versus SOC+placebo during Live Donor Nephrectomy for Transplant Am J Transplant. 2017;17 (suppl 3).

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