*Purpose: Laparoscopic donor nephrectomy has reduced the burden associated with open surgery, but a significant percentage of donors still suffer from postoperative pain. It is recognized that multimodal analgesic methods are superior for postoperative pain relief. While opioids provide good analgesia, they are far from being ideal analgesics due to their adverse effects, such as nausea and constipation. The purpose of this study was to assess the impact of the implementation of a standardized protocol for the management of postoperative pain status post living donor nephrectomy in order to optimize pain control, minimize adverse effects and facilitate faster patient recovery.

*Methods: This was a single-center, retrospective chart review of all living donor kidney patients who received a donor nephrectomy from June 1, 2016 through November 15, 2018. A total of 71 patients were screened for inclusion in the study, of which 66 met inclusion criteria. The primary outcome of this study was hospital length of stay post donor nephrectomy. Secondary outcomes included time to discontinuation of pain medication post-nephrectomy and documented adverse effects from pain medication.

*Results: A total of 34 patients received the standardized pain management protocol, which included a fentanyl patient controlled analgesia (PCA) pump starting in the operating room through post-operative day (POD) 1 at 0800, oxycodone 5mg PO ONCE at 0600 on POD1, tramadol 50mg PO every 6 hours first dose at 1200 on POD1 and acetaminophen 650mg PO every 6 hours first dose at 0900 on POD1. These patients were compared to 32 patients who received non-standardized pain management regimens consisting of as needed administration of morphine, hydromorphone, acetaminophen, hydrocodone/acetaminophen and/or oxycodone post-operatively. The average length of stay in the standardized pain management group was 1.5 (±0.71) days compared to 2 (±0.62) days in the non-standardized group (p=0.003). There was no difference between the two groups in time to discontinuation of pain medication or documented adverse effects from pain medication.

*Conclusions: The implementation of a standardized protocol for the management of postoperative pain status post living donor nephrectomy resulted in a decreased hospital length of stay without increasing incidence of adverse effects from pain medication.

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