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Marti K, Rochon C, O'Sullivan DM, Ye X, Ebcioglu Z, Kainkaryam PP, Kuzaro H, Morgan G, Serrano OK, Singh J, Tremaglio J, Kutzler HL. Evaluation of a multimodal analgesic regimen on outcomes following laparoscopic living donor nephrectomy. Clin Transplant 2021; 35:e14311. [PMID: 33829561 DOI: 10.1111/ctr.14311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/24/2021] [Accepted: 04/01/2021] [Indexed: 11/29/2022]
Abstract
Postoperative pain is a significant source of morbidity in patients undergoing living donor nephrectomy (LDN) and a deterrent for candidates. We implemented a standardized multimodal analgesic regimen, which consists of pharmacist-led pre-procedure pain management education, a combination transversus abdominis plane and rectus sheath block performed by the regional anesthesia team, scheduled acetaminophen and gabapentin, and as-needed opioids. This single-center retrospective study evaluated outcomes between patients undergoing LDN who received a multimodal analgesic regimen and a historical cohort. The multimodal cohort had a significantly shorter length of stay (LOS) (days, mean ± SD: 1.8 ± 0.7 vs. 2.6 ± 0.8; p < .001) and a greater proportion who were discharged on postoperative day (POD) 1 (38.6% vs. 1.5%; p < .001). The total morphine milligram equivalents (MME) that patients received during hospitalization were significantly less in the multimodal cohort on POD 0-2. The outpatient MME prescribed through POD 60 was also significantly less in the multimodal cohort (median [IQR]; 180 [150-188] vs. 225 [150-300]; p < .001). The mean patient-reported pain score (PRPS) was significantly lower in the multimodal cohort on POD 0-2. The maximum PRPS was significantly lower on POD 0 (mean ± SD: 7 ± 2 vs. 8 ± 1, respectively; p = .02). This study suggests that our multimodal regimen significantly reduces LOS, PRPS, and opioid requirements and has the potential to improve the donation experience.
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Affiliation(s)
- Kristen Marti
- Department of Pharmacy Services, Hartford Hospital, Hartford, CT, USA
| | - Caroline Rochon
- Department of Transplant, Hartford Hospital, Hartford, CT, USA
| | - David M O'Sullivan
- Department of Research Administration, Hartford HealthCare, Hartford, CT, USA
| | - Xiaoyi Ye
- Department of Transplant, Hartford Hospital, Hartford, CT, USA
| | - Zeynep Ebcioglu
- Department of Transplant, Hartford Hospital, Hartford, CT, USA
| | | | - Hillary Kuzaro
- Department of Pharmacy Services, Hartford Hospital, Hartford, CT, USA.,Department of Transplant, Hartford Hospital, Hartford, CT, USA
| | - Glyn Morgan
- Department of Transplant, Hartford Hospital, Hartford, CT, USA
| | - Oscar K Serrano
- Department of Transplant, Hartford Hospital, Hartford, CT, USA
| | - Joseph Singh
- Department of Transplant, Hartford Hospital, Hartford, CT, USA
| | | | - Heather L Kutzler
- Department of Pharmacy Services, Hartford Hospital, Hartford, CT, USA.,Department of Transplant, Hartford Hospital, Hartford, CT, USA
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