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Doronio GM, Lee ASD. The Effect of Implementing a Standardized Enhanced Recovery After Surgery Pain Management Pathway at an Urban Medical Center in Hawaii. AORN J 2023; 118:391-403. [PMID: 38011055 DOI: 10.1002/aorn.14038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 11/28/2022] [Indexed: 11/29/2023]
Abstract
Traditional use of opioids to treat postoperative pain may lead to abuse and overdose. The development of Enhanced Recovery After Surgery (ERAS) protocols has helped to shift pain management from traditional methods to evidence-based best practices involving multimodal analgesia techniques. The purpose of this quality improvement project was to implement and determine the effectiveness of a standardized, evidence-based ERAS pain management pathway for patients undergoing colorectal or gynecology procedures at a medical center in Hawaii. After the intervention, the evaluation of data associated with opioid use, patients' pain scores, time spent in the postanesthesia care unit, and inpatient length of stay showed that most results were not significant. However, the ERAS pain management pathway did reduce clinical practice variations, intraoperative opioid administration, the time that patients spent in the postanesthesia care unit, and length of stay. The ERAS pain management pathway continues to be used and updated at this facility.
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Atherton SW, Massey MS, Nguyen T, Wang DW, Subramaniam K, Abdelwahid E, Bahnaswy A, Trostler MS, Lombardero M, Planinsic R, Abuelkasem E. Evaluating a unique enhanced recovery protocol in laparoscopic donor nephrectomy: A single center experience. Clin Transplant 2023; 37:e15051. [PMID: 37335310 DOI: 10.1111/ctr.15051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/24/2023] [Accepted: 06/07/2023] [Indexed: 06/21/2023]
Abstract
INTRODUCTION Enhanced recovery after surgery (ERAS) protocols have been associated with a reduction in opioid consumption and a hastening in recovery in abdominal surgery. However, their impact on laparoscopic donor nephrectomy (LDN) has not been fully elucidated. The aim of this study is to evaluate opioid consumption and other relevant outcome measures before and after implementation of a unique LDN ERAS protocol. METHODS 244 LDN patients were included in this retrospective cohort study. Forty-six underwent LDN prior to implementation of ERAS, whereas 198 patients received ERAS perioperative care. The primary outcome was daily oral morphine equivalent (OME) consumption averaged over the entire postoperative stay. Due to removal of preoperative oral morphine from the protocol partway through the study period, the ERAS group was further subdivided into morphine recipients and non-recipients for subgroup analysis. Secondary outcomes included the incidence of postoperative nausea and vomiting (PONV), length of stay, pain scores, and other relevant measures. RESULTS ERAS donors consumed significantly fewer average daily OMEs than Pre-ERAS donors (21.5 vs. 37.6, respectively; p < .0001). There were no statistically significant differences in OME consumption between morphine recipients and non-recipients. The ERAS group experienced less PONV (44.4% requiring one or more rescue antiemetic postoperatively, vs. 60.9% of Pre-ERAS donors; p = .008). CONCLUSIONS A protocol pairing lidocaine and ketamine with a comprehensive approach to preoperative PO intake, premedication, intraoperative fluid management and postoperative pain control is associated with reduced opioid consumption in LDN.
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Affiliation(s)
- Samuel W Atherton
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michael S Massey
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Tho Nguyen
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - David W Wang
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kathirvel Subramaniam
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Eman Abdelwahid
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ahmed Bahnaswy
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michael S Trostler
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Manuel Lombardero
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Raymond Planinsic
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ezeldeen Abuelkasem
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Lee JE, Kim HY, Lee KW, Kim GS. Second-generation supraglottic airway in laparoscopic donor nephrectomy. Sci Rep 2023; 13:8406. [PMID: 37225750 DOI: 10.1038/s41598-023-34691-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/05/2023] [Indexed: 05/26/2023] Open
Abstract
Supraglottic airway (SGA) may have advantages over endotracheal tube (ETT) regarding laryngospasm, coughing, sore throat, and hemodynamic changes; however, studies on the use of SGA in laparoscopic donor nephrectomy (LDN) are lacking. Here, we aimed to confirm the safety and feasibility of second-generation SGA in LDN and compare them with those of ETT. Enrolled adult donors (aged > 18 years) who underwent LDN between August 2018 and November 2021 were divided into two groups-ETT vs. SGA. Airway pressure, lung compliance, desaturation, and hypercapnia were recorded during surgery. After propensity score matching for baseline characteristics and surgical duration, 82 and 152 donors were included in the ETT and SGA groups, respectively, and their outcomes were compared. The peak airway pressure was lower in the SGA group than in the ETT group 5 min after pneumoperitoneum. Dynamic lung compliance was higher in the SGA group than in the ETT group during surgery. There were no cases of intraoperative desaturation, hypercapnia, or postoperative aspiration pneumonitis. The use of second-generation SGA, a safe alternative to ETT for LDN, resulted in reduced airway resistance and increased lung compliance, which suggests its benefits for airway management in kidney donors.
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Affiliation(s)
- Ja Eun Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ha Yeon Kim
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Kyo Won Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gaab Soo Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Amer A, Scuffell C, Dowen F, Wilson CH, Manas DM. A national survey on enhanced recovery for renal transplant recipients: current practices and trends in the UK. Ann R Coll Surg Engl 2023; 105:166-172. [PMID: 35446720 PMCID: PMC9889185 DOI: 10.1308/rcsann.2021.0365] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2021] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Enhanced recovery after surgery (ERAS) is well established in many specialties but has not been widely adopted in renal transplantation. The aim of this survey was to understand current national practices and sentiment concerning ERAS for renal transplant recipients in the UK. METHODOLOGY A national web-based survey was sent to consultant surgeons at all 23 UK adult renal transplant units. Completed questionnaires were collected between May and July 2020. Data were analysed according to individual responses and grouped according to the existence of formal ERAS pathways within units. RESULTS All transplant units were represented in this survey. Three units had a formal ERAS pathway for all recipients. Of the remaining units, 65.9% considered implementing an ERAS pathway in the near future. The most commonly perceived barrier to ERAS implementation was 'embedded culture within transplant units' (54.8% of respondents). A fifth of respondents insert surgical drains selectively and 11.7% routinely discontinue patient-controlled analgesia on postoperative day 1. Most respondents routinely remove urinary catheters on day 5 (70%) and ureteric stents 4-6 weeks post-transplantation (81.7%). Median length of stay for deceased donor kidney transplant recipients was lower in units with ERAS programmes (5-7 days versus 8-10 days, respectively). The main cited barriers for discharge were 'suboptimal fluid balance' and 'requirement of treatment for rejection'. CONCLUSIONS Despite slow uptake of ERAS in kidney transplantation, appetite appears to be increasing, particularly in the post-COVID-19 era. The current practice and opinions of transplant specialists highlighted in this survey may help to establish nationally agreed ERAS guidelines in this field.
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Kuiper M, Gillingham M, Martin J, Gardner D, Van Calcar S. The Effect of Preoperative Carbohydrate Intake on Length of Stay and Postoperative Recovery Following Laparoscopic Living Donor Nephrectomy. J Ren Nutr 2022; 33:405-411. [PMID: 36549407 DOI: 10.1053/j.jrn.2022.12.005] [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: 07/24/2022] [Revised: 10/21/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Enhanced Recovery After Surgery (ERAS) protocols are applied in many surgical procedures and often involve preoperative carbohydrate intake. Research surrounding the utility of ERAS in living donor nephrectomy is limited. The objective of this study was to identify whether living kidney donors who received preoperative oral carbohydrates experienced a difference in length of hospital stay (LOS), duration of time required to resume regular oral food and fluid intake, and incidence of gastrointestinal (GI) complications following laparoscopic nephrectomy compared to historical control donors who underwent preoperative fasting. METHODS This study was a retrospective analysis of data from adult subjects at one transplant center who underwent laparoscopic living donor nephrectomy. A total of 55 ERAS subjects who received preoperative carbohydrates and 93 historical control subjects who underwent preoperative fasting were included in the final analysis. The following variables were compared between groups: LOS, time to tolerating a regular oral diet postoperatively, time to meeting 50% of estimated fluid needs by oral intake postoperatively, and incidence of postoperative GI complications. RESULTS No significant differences between the ERAS and historical control groups in age, weight, body mass index, sex distribution, or estimated fluid needs were identified. Both groups consisted of predominantly female subjects. ERAS subjects experienced a shorter LOS (2.8 days versus 3.9 days, P < .001), time to tolerating a regular oral diet (36.5 hours versus 68.2 hours, P < .001), and time to meeting 50% of estimated fluid needs (25.3 hours versus 44.6 hours, P < .001) after laparoscopic nephrectomy compared to historical control subjects. No significant difference between groups in the incidence of postoperative GI complications (nausea, vomiting, or ileus) was identified. CONCLUSION Our findings demonstrate the advantages of ERAS in living kidney donors undergoing laparoscopic nephrectomy and support ERAS implementation within this patient population.
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Affiliation(s)
- Morgan Kuiper
- Registered Dietitian II, Sodexo at PeaceHealth Sacred Heart Medical Center at RiverBend, Springfield, OR.
| | - Melanie Gillingham
- Associate Professor, Graduate Programs in Human Nutrition, Oregon Health & Science University, Portland, OR
| | - Julie Martin
- Clinical Dietitian, Providence Newberg Medical Center, Newberg, OR
| | - Daniella Gardner
- Clinical Dietitian, Oregon Health & Science University, Portland, OR
| | - Sandra Van Calcar
- Associate Professor, Graduate Programs in Human Nutrition, Oregon Health & Science University, Portland, OR
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Roebuck EH, Ivan SJ, Robinson MM, Worrilow WM, Gaston KE, Matulay JT, Roy OP, Clark PE, Riggs SB. Impact of dedicated renal enhanced recovery after surgery (RERAS) program on postoperative opioid consumption and evaluation of surgeon-specific compliance to the program. Urol Oncol 2022; 40:383.e23-383.e29. [PMID: 35752565 DOI: 10.1016/j.urolonc.2022.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/13/2022] [Accepted: 03/31/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND OBJECTIVE Enhanced Recovery After Surgery (ERAS) protocols have been increasingly applied to urologic surgeries such as cystectomy and prostatectomy, though research defining protocols and outcomes for renal ERAS programs (RERAS) for nephrectomy remains limited. We aim to assess perioperative outcomes following implementation of our RERAS protocol modified from ERAS society cystectomy guidelines, as well as describe compliance with protocol guidelines. METHODS We performed a retrospective cohort analysis of 400 patients who underwent partial or radical nephrectomy between October 2017 and August 2020. RERAS protocol was initiated September 30, 2018, and patients were categorized into pre- and post-RERAS implementation cohorts based on surgery date. Perioperative outcomes including complications, 30-day readmissions, length of stay, and opioid consumption were compared across pre- and post-RERAS cohorts. Protocol compliance was reported based on adherence to program recommendations. RESULTS Among 400 patients included in analysis, the pre-RERAS cohort included 133 patients and the post-RERAS cohort included 267 patients. There were no differences in overall complications (P = 0.354) and 30-day readmissions (P = 0.078). Length of stay (P < 0.001) and postoperative opioid consumption (P < 0.001) were significantly reduced post-RERAS. We observed an increase in compliance with RERAS recommendations over time (P< 0.001). CONCLUSION RERAS implementation was associated with decreased length of stay and opioid usage, underscoring the benefits of program adoption in an era of opioid dependence and strained hospital capacity. Successful initiation of a RERAS protocol requires intentional organization and buy in from all providers involved.
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Affiliation(s)
- Emily H Roebuck
- Department of Urology, Carolinas Medical Center/Atrium Health, Charlotte, NC
| | - Samuel J Ivan
- Department of Urology, Carolinas Medical Center/Atrium Health, Charlotte, NC
| | - Myra M Robinson
- Department of Cancer Biostatistics, Levine Cancer Institute/Atrium Health, Charlotte, NC
| | - William M Worrilow
- Department of Urology, Carolinas Medical Center/Atrium Health, Charlotte, NC
| | - Kris E Gaston
- Department of Urology, Carolinas Medical Center/Atrium Health, Charlotte, NC
| | - Justin T Matulay
- Department of Urology, Carolinas Medical Center/Atrium Health, Charlotte, NC
| | - Ornob P Roy
- Department of Urology, Carolinas Medical Center/Atrium Health, Charlotte, NC
| | - Peter E Clark
- Department of Urology, Carolinas Medical Center/Atrium Health, Charlotte, NC
| | - Stephen B Riggs
- Department of Urology, Carolinas Medical Center/Atrium Health, Charlotte, NC.
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Dong X, Burton BN, Little C, Woodhouse L, Grogan T, Blumberg JM, Gritsch HA, Rahman S. Intraoperative opioid and analgesic adjuvant administration practice patterns following implementation of an enhanced recovery after surgery protocol for laparoscopic donor nephrectomy. J Clin Anesth 2022; 79:110751. [PMID: 35334291 DOI: 10.1016/j.jclinane.2022.110751] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/04/2022] [Accepted: 03/09/2022] [Indexed: 01/19/2023]
Abstract
STUDY OBJECTIVE The primary aim of this study is to understand how intraoperative medication administration patterns change in response to ERAS® protocol implementation for patients who underwent laparoscopic donor nephrectomy. DESIGN Single-center, retrospective analysis of laparoscopic donor nephrectomy patients. SETTING Large tertiary academic medical center. PATIENTS We divided all cases of laparoscopic donor nephrectomies (n = 929) over seven years into three approximately equal time periods: Pre-ERAS 1 (n = 317), Pre-ERAS 2 (n = 297) and Post-ERAS (n = 315). MEASUREMENTS We examined patient demographics, intraoperative opioid and non-opioid pain adjuvant administration, Post Anesthesia Recovery Unit (PACU) pain scores and opioid use as well as PACU and hospital lengths of stay (LOS). MAIN RESULTS Segmented regression analysis of interrupted time series was utilized to evaluate the association of ERAS protocol implementation with the amount of intraoperative opioid and non-opioid pain adjuvant use. In adherence to our institutional ERAS protocol, there was a significant reduction in intraoperative fentanyl use after ERAS protocol of -70.2μg (95% CI -106.0, -34.2, p < 0.001) and a significant increase in intraoperative hydromorphone use of 0.47 mg (95% CI 0.284, 0.655, p < 0.001). However, in contrary to our ERAS protocol, we found no significant change in odds of receiving IV acetaminophen OR 1.31 (95% CI 0.450, 3.76, p = 0.613) or IV ketorolac OR 1.65 (95% CI 0.804, 3.41, p = 0.172) after ERAS protocol implementation. We found a significant reduction in PACU opioid use of -9.68 Morphine Milligram Equivalents (MME) (95% CI -17.1, -2.31, p = 0.010) but no significant change in PACU initial pain score, PACU LOS and hospital LOS. CONCLUSIONS We examined intraoperative practice pattern changes by anesthesiologists in response to ERAS protocol implementation for laparoscopic donor nephrectomies. Our results suggest that there was a variable uptake of recommendations from ERAS protocol. While ERAS protocols are often studied as a bundle of best practice recommendations, understanding the variability of provider adherence represents an important future research direction for the ERAS initiative.
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Affiliation(s)
- Xuezhi Dong
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 3325, Los Angeles, CA 90095, USA; Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
| | - Brittany N Burton
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 3325, Los Angeles, CA 90095, USA.
| | - Christopher Little
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 3325, Los Angeles, CA 90095, USA.
| | - Logan Woodhouse
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 3325, Los Angeles, CA 90095, USA.
| | - Tristan Grogan
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 3325, Los Angeles, CA 90095, USA.
| | - Jeremy M Blumberg
- Department of Urology, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue Box 951738, Los Angeles, CA 90095, USA.
| | - Hans A Gritsch
- Department of Urology, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue Box 951738, Los Angeles, CA 90095, USA.
| | - Siamak Rahman
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 3325, Los Angeles, CA 90095, USA.
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Feasibility, Safety and Efficacy of Enhanced Recovery After Living Donor Nephrectomy: Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med 2020; 10:jcm10010021. [PMID: 33374793 PMCID: PMC7795400 DOI: 10.3390/jcm10010021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/17/2020] [Accepted: 12/21/2020] [Indexed: 12/25/2022] Open
Abstract
This meta-analysis aims to compare enhanced recovery after surgery (ERAS) vs. standard perioperative practice in the management of living kidney donors. Primary endpoints included mortality, complications, length of stay (LOS) and quality of life after living donor nephrectomy. Medline, Embase, Scopus, Cochrane and Web of Science databases were searched. In total, 3029 records were identified. We then screened 114 full texts. Finally, 11 studies were included in the systematic review corresponding to 813 living donors. Of these, four randomized controlled trials were included in the meta-analysis. ERAS resulted in shorter LOS (95CI: −1.144, −0.078, I2 = 87.622%) and lower incidence of post-operative complications (95CI: 0.158, 0.582, I2 = 0%). This referred to Clavien–Dindo I-II complications (95CI: 0.158, 0.582, I2 = 0%). There was no difference in Clavien–Dindo III-V complications (95CI: 0.061,16.173, I2 = 0%). ERAS donors consumed decreased amounts of narcotics during their hospital stay (95CI: −27.694, −8.605, I2 = 0%). They had less bodily pain (95CI: 6.735, 17.07, I2 = 0%) and improved emotional status (95CI: 6.593,13.319, I2 = 75.682%) one month postoperatively. ERAS protocols incorporating multimodal pain control interventions resulted in a mean reduction of 1 day in donors’ LOS (95CI: −1.374, −0.763, I2 = 0%). Our results suggest that ERAS protocols result in reduced perioperative morbidity, shorter length of hospital stay and improved quality of life after living donor nephrectomy.
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Bellini MI, Wilson RS, Veitch P, Brown T, Courtney A, Maxwell AP, D'Andrea V, McDaid J. Hyperamylasemia Post Living Donor Nephrectomy Does Not Relate to Pain. Cureus 2020; 12:e8217. [PMID: 32582478 PMCID: PMC7306643 DOI: 10.7759/cureus.8217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction The aetiology of pain after laparoscopic donor nephrectomy remains unclear. Given the proximity of the left kidney to the tail of the pancreas, we aimed to assess whether mobilisation and retrieval of the left kidney might inflame the pancreas, leading to pain and hyperamylasaemia in the post-operative period. Patient and methods In the present study, 16 consecutive live kidney donors were analysed in the same three months period. Amylase levels were measured on days 1 and 2. For each 24-hour period post-operatively analgesia consumption was recorded, as well as pain scores at rest on a visual analogue scale (VAS). Results Three out of 16 donors presented hyperamylasemia. A multiple regression analysis found levobupivacaine dose, propofol dose, transversus abdominis plane block and day 1 amylase did not significantly predict pain scores. Interestingly, body mass index significantly correlated with increased pain scores (p = 0.041). Also, increasing CO2 insufflation pressure and use of local anaesthetic infusion catheters predicted a decreased deep pain score (p = 0.036 and p = 0.037). Conclusion There was no correlation of amylase levels and pain scores. Pancreatitis is a rare complication of nephrectomy and no overt cases were seen in the case of donor nephrectomy.
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Affiliation(s)
| | - Rebekah S Wilson
- Regional Transplant Unit, Belfast Health and Social Care Trust, Belfast, GBR
| | - Peter Veitch
- Regional Transplant Unit, Belfast Health and Social Care Trust, Belfast, GBR
| | - Tim Brown
- Regional Transplant Unit, Belfast Health and Social Care Trust, Belfast, GBR
| | - Aisling Courtney
- Regional Transplant Unit, Belfast Health and Social Care Trust, Belfast, GBR
| | | | | | - James McDaid
- Regional Transplant Unit, Belfast Health and Social Care Trust, Belfast, GBR
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