Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: Multimodal analgesia with non-opioid analgesics in the setting of enhanced recovery after surgery (ERAS) pathway has proven beneficial in managing pain and decreasing adverse outcomes in kidney donors following surgery. Data assessing similar outcomes in kidney transplant recipients (KTRs) is limited. The purpose of this study was to evaluate the effectiveness of implementing an ERAS pathway to limit overall narcotic use in KTRs.
*Methods: This retrospective study of KTRs included recipients >18 years old who received a kidney transplant between January 2017 to July 2019. The ERAS pathway, which included scheduled acetaminophen, gabapentin, and as needed tramadol for multimodal analgesia, was implemented in August 2018. Recipients were excluded if they received a dual organ transplant. The primary endpoint was to compare ERAS vs non-ERAS opioid requirements in morphine milligram equivalents (MME) during transplant admission. Secondary endpoints included comparison of pain scores, length of stay, opioid use six months post-discharge, re-admissions within one month post-discharge, and the evaluation of KTRs that did not follow ERAS after implementation.
*Results: 217 KTRs met criteria with no significant differences in age, gender, race or donor type between ERAS and non-ERAS cohorts. Inpatient opioid use was significantly reduced following implementation of ERAS along with a significant reduction of overall opioid use post-discharge (Table 1). However, inpatient opioid use in the living donor recipients and average inpatient pain scores were not significantly different. Readmissions were significantly reduced in the ERAS cohort compared to non-ERAS (15 vs 56, p<0.02). For KTRs who did not follow ERAS (n=30), 27% were on opioids within six months prior to transplant suggestive of chronic use or tolerance; however, 30% of those that did not fully follow our ERAS pathway were discharged with non-opioids. Reasons for deviation from those in the ERAS cohort were any use of oxycodone inpatient or script of oxycodone at discharge (n=25, 83.3%) and/or requirement of intravenous pain medications beyond post-operative day one (n=11, 36.7%).
*Conclusions: Multimodal analgesia within the ERAS pathway is beneficial in KTRs to provide adequate pain control with limited to no exposure of opioids during admission or at discharge without adversely affecting outcomes.
|Non-ERAS (n=147)||ERAS (n=70)||p-value|
|Inpatient Opioid Use (MME/day)||24.7 + 19.7||16.5 + 19.2||0.004|
|Length of Stay (days)||7.3 + 5.8||7.1 + 6.4||0.8|
|Opioid Use Post-Discharge No Use||10 (7)||35 (50)||<0.005|
|Level 1: >0 to 150 mg||1 (0.6)||9 (13)||<0.005|
|Level 2: 151-300 mg||10 (7)||5 (7)||0.926|
|Level 3: 301-500 mg||89 (61)||15 (21)||<0.005|
|Level 4: >500 mg||37 (25)||6 (9)||0.007|
To cite this abstract in AMA style:Muir MA, Szempruch KR, Dupuis RE, Toledo AH, Rodriguez PSerrano. Evaluating Postoperative Opioid Requirements of Kidney Transplant Recipients [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/evaluating-postoperative-opioid-requirements-of-kidney-transplant-recipients/. Accessed August 8, 2020.
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