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Effects of a Multimodal Pain Control Regimen in Living Donor Laparoscopic Nephrectomies

E. Thomas, J. Nelson, E. Diaz.

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

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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).

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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.

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