*Purpose: Opioid sparing pain control protocols are widely accepted within health systems nationwide. In living donor kidney transplantation, pain control is addressed in a multimodal fashion. Per the Michigan Opioid Prescribing Engagement Network (OPEN), patients should be discharged with 0-10 tablets of 5 mg oxycodone without the need for additional opioid prescriptions. This analysis sought to describe pain management prescribing patterns following living donor nephrectomy at a large, academic transplant center.

*Methods: Single-center, retrospective review of living, laparoscopic kidney donors from 2017 through 2020 was performed. Preoperative analgesia, time to discharge, discharge analgesia and frequency of subsequent opioid prescriptions were abstracted from the medical record. Descriptive statistics were utilized.

*Results: During the study period, 386 nephrectomies were completed. Preoperative pain management primarily included acetaminophen (n=265, 69%), pregabalin (n=238, 62%) and celecoxib (n=68, 18%). Median day of discharge was post-op day 2 with 30% of patients being discharged on post-op day 1. Of patients discharged post-op day 1, 91 (78%) received both pregabalin and acetaminophen during the peri-operative period. At discharge, 12 patients received no pain medication, 352 patients were dispensed one agent, and 22 patients were dispensed two. Most commonly, patients were discharged with oxycodone 5 mg (n=328, 85%), followed by hydromorphone 2 mg (n=20, 5.2%), and tramadol 50 mg (n=20, 5.2%). The median number of opioid tablets dispensed at the time of discharge was 20 (IQR: 20, 45). The most common secondary agent was diazepam (n=17, 4.8%). Fifteen patients (3.8%) required an additional opioid prescription within a mean time of 6 days (IQR: 3-10) post-discharge.

*Conclusions: Current preoperative and discharge pain control prescribing was shown to be highly variable and often included higher than recommended opioid quantities albeit few required an additional opioid prescription. To improve alignment with recommended opioid sparing pain regimens and facilitate early post-op discharge, an enhanced recovery after surgery (ERAS) pathway will be developed to include utilization of prespecified preoperative analgesia, scheduled outpatient acetaminophen and opioid quantity limits of 10 tablets of oxycodone 5 mg at discharge. Future quality assurance analysis will be performed to assess the ERAS pathway success.

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