INTRODUCTION: The proliferation of live donor kidney transplant is due in part to the application of minimally invasive surgical techniques. The introduction of robotics to the donor operation, adds another layer of refinement that may improve the donor experience by reducing narcotic use, length of stay, and postoperative pain. The following is our experience using IV APAP administration in the peri-operative period, comparing standard hand assist vs robotic nephrectomy and its impact on post op narcotic use and length of stay.
METHODS: This is a retrospective study of narcotic minimization and a comparison of hand assist vs. robotic assisted live donor nephrectomy at a single center between June and September 2012. In May of 2012, our center approved the use of IV APAP. 22 living kidney donors received intraoperative dosing of IV APAP followed by 3 postop doses q6h in the first 24 hrs. This group was compared to 23 donors in the preceding 6 months who did not received IV APAP. All donors in the study and control groups received ketorolac 30 mg IV q8h in the first 24 hrs post op as part of our standard protocol. Subgroup analysis included a comparison of robotic vs hand-assisted laparoscopic nephrectomy. Primary endpoints were total narcotic usage and length of stay.
|Control(hand assist+robotic w/o APAP) (n=23)||IV APAP(n=22)|
|Length of stay||2.6 days||2.2 days|
|PO oxycodone cumulative dose||28 mg||28 mg|
|IV hydromorphone cumulative dose(p<0.05)||1.5 mg||0.3 mg|
|Laparoscopic Hand Assist||Robotic|
|Overall LOS p=NS||65.1hrs||55.7hrs||53.9hrs||48.8hrs|
|Mean Oxycodone PO Cumulative Dose||29mg||29mg||24mg||28mg|
|Mean Hydromorphone IV cumulative dose p<0.05||1.1mg||0.1mg||2.9mg||0.5mg|
CONCLUSION:Overall, donors receiving 24 hrs of IV APAP had significantly reduced IV narcotic requirements regardless of hand assist or robotic technique. There is a trend towards decreased length of stay in the robotic group although it is unclear whether this is due to robotic technique, APAP or both. The benefits of reduced narcotic use and the potential for decreased post operative pain associated with IV APAP may potentially decrease donor post operative morbidity and augment overall patient satisfaction. Utilization of robotic techniques may also help decrease LOS although it did not achieve significance in this study and warrants further investigation.
To cite this abstract in AMA style:Tan M, Ommert T, Cross R, Mulloy M, D'Annunzio S, Johnson M, Pollinger H. Role of IV Acetaminophen (APAP) in Reducing Narcotic Use in Live Donor Nephrectomy, The [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/role-of-iv-acetaminophen-apap-in-reducing-narcotic-use-in-live-donor-nephrectomy-the/. Accessed October 28, 2020.
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