Optimal Perioperative Management of Patients Undergoing Living Donor Nephrectomy Reduces Postoperative Length of Stay and Nausea and Vomiting
1Anesthesiology and Perioperative Medicine, Mayo Clinic Florida, Jacksonville, FL, 2Transplant Surgery, Mayo Clinic Florida, Jacksonville, FL
Meeting: 2020 American Transplant Congress
Abstract number: 135
Keywords: Donation, Kidney, Living donor, Resource utilization
Session Information
Session Name: Kidney Living Donor: Other I
Session Type: Oral Abstract Session
Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:45pm
Presentation Time: 4:03pm-4:15pm
Location: Virtual
*Purpose: Renal transplantation with organs from living donors saves thousands of lives every year. In the perioperative period, poorly controlled nausea and pain can prolong length of stay (LOS) and slow recovery. In addition, opioid-based analgesia regiments can worsen these postoperative symptoms. However, it is hypothesized with a standardized anesthesia and postoperative analgesic protocol, a reduction be made in the both the length of stay and postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic donor nephrectomy.
*Methods: A standardized anesthesia and postoperative analgesic protocol was put into place with an emphasis on multimodal analgesia with reduced opioids and multimodal PONV prophylaxis. (See Table) Retrospectively, data was collected from the control group (June 2015 to May 2017) and the new protocol group (June 2017 to December 2018). Data collected included LOS, clinically significant PONV from postoperative day (POD) #0 to discharge (defined as receiving antiemetics in both the Post Anesthesia Care Unit (PACU) and the floor, or multiple, different antiemetics at either location), and average pain scores in the PACU and floor. Continuous variables were summarized as mean (standard deviation), while categorical variables were reported as frequency (percentage). Continuous baseline and postoperative variables were compared between the pre- and post-standardization groups using Wilcoxon rank sum test and categorical variables were compared using Chi-squared test. All tests were two-sided with alpha level set at 0.05 for statistical significance.
*Results: There were 78 patients in the control group and 74 patients in the new protocol group, with no statistically significant differences in terms of age and sex. LOS was significantly less in the new protocol group (1.2 +/ 0.4; p< .0001) versus the control group (2.2 +/- 0.4; p< .0001). The incidence of clinically significant PONV on POD #0 was significantly less in the new protocol group versus the control group (18.9% versus 33.8%; p = .039), as well on POD #1 to discharge. (6.8% versus 19.5%; p = .021). There were no significant differences between average pain scores in PACU and floor in both groups.
*Conclusions: In conclusion, application of a standardized anesthesia and postoperative analgesic protocol for laparoscopic donor nephrectomy reduces LOS and PONV with no negative effect on donor analgesia.
| Anesthetic Protocol |
| Analgesia: All patients will receive acetaminophen 1000mg IV with induction of anesthesia unless contraindicated. At the conclusion of the case, after confirmation with the surgical team, the patient will receive ketorolac 15mg IV. The hand-port incision will be infiltrated with ropivacaine 0.5%. Narcotics can be administered in the operating room as needed at the discretion of the anesthesiology team. |
|
Nausea and vomiting prophylaxis: All patients should receive ondansetron 4 mg IV and dexamethasone 10mg IV. High risk patients (e.g. females, history of PONV) should receive an additional antiemetic at the discretion of the anesthesiology team (e.g. haloperidol 2mg IV, promethazine 6.25mg IV, or scopolamine patch placed preoperatively) and should be considered for a total intravenous anesthetic. |
| Postoperative Analgesic Protocol |
| PACU: For pain scores >5, the patient will receive IV narcotics. Anti-emetics will be administered depending on the operating room administration. |
| Floor: Patient will be on acetaminophen 1000mg PO q6 and ketorolac 15mg IV q6. PO narcotics will be given prn for moderate pain, and IV narcotics will be given prn for severe pain.(Pain score > 6). No PCA will be utilized. |
To cite this abstract in AMA style:
Chadha R, Aniskevich S, Perry D, Taner C, Burns J. Optimal Perioperative Management of Patients Undergoing Living Donor Nephrectomy Reduces Postoperative Length of Stay and Nausea and Vomiting [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/optimal-perioperative-management-of-patients-undergoing-living-donor-nephrectomy-reduces-postoperative-length-of-stay-and-nausea-and-vomiting/. Accessed November 22, 2024.« Back to 2020 American Transplant Congress