*Purpose: The purpose of this study is to examine the use of a multimodal pain regimen in our diverse population to better characterize short and long-term donor outcomes.

*Methods: A single-center retrospective chart review was conducted to include patients between January 1, 2018 and October 1, 2020. Adult kidney living donors were included if they underwent a laparoscopic nephrectomy. Open nephrectomies and patients with an allergy to nonsteroidal anti-inflammatory drugs (NSAIDs) were excluded. Historical pain control at our institution included ketorolac starting post-operative day (POD) 1, with hydromorphone PCA immediately post-op with transition to intermittent bolus dosing with oxycodone/acetaminophen, as needed. The primary outcome was total morphine milligram equivalents (MME) used during admission. Secondary outcomes included pain scores immediately, 24 hours, and 48 hours postoperatively, hospital length of stay, glomerular filtration rate (GFR) and GFR percentage within the first year of nephrectomy.

*Results: Fifty patients were included in the preliminary data, with 48 patients having received at least one dose of ketorolac as part of a multimodal pain regimen. Patients used a median of 67.3 MME during their admission. Median pain scores were reflective of mild pain immediately, 24 hours and 48 hours postoperatively (0, 3, and 0, respectively). Average GFR was similar between ketorolac groups at 2 weeks, 6 months and 1 year (66, 69, and 68 mL/min/1.73 m², respectively), as well as GFR percentage (63%, 66%, and 65%, respectively). Living donors had an average length of stay of 69.5 hours. No safety differences were observed regarding renal function and ketorolac dose using GFR percentage (Table 4).

*Conclusions: In kidney living donors undergoing laparoscopic nephrectomies, multimodal pain regimens result in overall moderate opioid use, mild pain during admission, and hospital stay of approximately 3 days, without significant safety effects on renal function within this observation period. Further comparison with an optimized enhanced recovery after surgery (ERAS) protocol including pre-operative celecoxib, gabapentin and scheduled acetaminophen with results pending for the spring.

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