Effects of a Multimodal Pain Control Regimen in Living Donor Laparoscopic Nephrectomies
Department of Surgery, University of Florida, Gainesville, FL.
Meeting: 2018 American Transplant Congress
Abstract number: 223
Keywords: Length of stay, Nephrectomy, Outcome, Pain
Session Information
Date: Monday, June 4, 2018
Session Name: Concurrent Session: Kidney Living Donation: Donor and Recipient Outcomes
Session Time: 2:30pm-4:00pm
Presentation Time: 3:30pm-3:42pm
Location: Room 6E
Purpose: Evaluate the effects of a multimodal pain control regimen on length of stay (LOS), opioid consumption, pain control, and opioid/NSAID related adverse events in living donor nephrectomies.
Methods: This single-center, retrospective review evaluated all patients who underwent laparoscopic living donor nephrectomy from June 2013 to June 2017. Cohorts were compared before (cohort 1, n = 55) and after (cohort 2, n = 23) the introduction of a multimodal pain control protocol. The protocol consisted of a preoperative dose of gabapentin, intra-operative local injection of lidocaine, bupivacaine, and epinephrine, intra-operative dose of IV acetaminophen and ketorolac post nephrectomy then scheduled post-operative acetaminophen, and ketorolac. Opioids and benzodiazepines were given on an as needed basis. Patients were excluded if they had history of narcotic use or had other procedures during nephrectomy. The primary endpoint was LOS. Secondary endpoints included opioid consumption, average daily pain scores, and rates of opioid- and NSAID- related adverse effects
Results : Patient demographics were comparable between cohorts. Cohort 1 had significantly higher rates of PCA use (p = < 0.001) and trended towards higher rates of epidural use (p = 0.1). Cohort 2 consumed significantly more acetaminophen on POD2 (p = <0.001) and ketorolac (<0.0001).
| Efficacy endpoints | Cohort1 n=55 | Cohort2 n=23 | p-value |
| LOS(dys) | 5 [5-4] | 4[4-3] | 0.0001 |
| Ileus | 6 (11%) | 3(13%) | 1.00 |
| Return of flatus(dys) | 2.5 [3-2] | 2[2-1] | 0.0003 |
| Return of stool(dqys) | 3[3.3-3] | 3[3-2] | 0.01 |
| PCA usage(dys) | 1 [2-1] | 1[1-0] | <0.0001 |
| Pain score POD0-1 | 3 [4-1.8] | 2.8[4.6-2.3] | 0.42 |
| Pain score POD1-2 | 3.3 [4-1.6] | 2.6 [3.8 -1.5] | 0.35 |
| Pain score POD2-3 | 2.4[ 3.7-1.8] | 2.2[3-1.2] | 0.38 |
In assessing NSAID-associated adverse effects, there was no difference in UOP on POD1 (p = 0.7), SCr on POD1 (p = 0.55), 2 (p = 0.32), 3 (p = 0.84) or outpatient clinic visit (p = 0.42). There were no GI bleeds.
Conclusion: Living donor nephrectomy patients who received a multimodal pain control regimen had reduced LOS and PCA usage. Average pain score, and NSAID-associated adverse effects were similar. Use of a multimodal pain control regimen improves postoperative care of this patient population and shortens LOS.
CITATION INFORMATION: Thomas E., Nelson J., Diaz E. Effects of a Multimodal Pain Control Regimen in Living Donor Laparoscopic Nephrectomies Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Thomas E, Nelson J, Diaz E. Effects of a Multimodal Pain Control Regimen in Living Donor Laparoscopic Nephrectomies [abstract]. https://atcmeetingabstracts.com/abstract/effects-of-a-multimodal-pain-control-regimen-in-living-donor-laparoscopic-nephrectomies/. Accessed January 25, 2021.« Back to 2018 American Transplant Congress