An Evaluation of the Effect of Catheter-Directed Continuous Infusion of Local Anesthetic by Elastomeric Pump on Opioid Usage Following Donor Kidney Nephrectomy

Abstract

Background Postoperative pain management following donor nephrectomy can prove challenging for immediate discharge on postoperative day 1 or 2. Although the standard for pain control is utilization of opioids, this increases the risk of postoperative ileus and, if continued inappropriately, increases excess opioids circulating in the community. One strategy that proposes to limit postoperative opioids in kidney donors is the continuous infusion of local anesthetics (CILA), though the effect on patient outcomes is unclear. Objective The purpose of this study was to evaluate the effectiveness of postoperative CILA to decrease opioid usage in kidney donors who undergo laparoscopic nephrectomy. Methods A retrospective analysis was conducted of kidney donors who underwent laparoscopic nephrectomy and received CILA (CILA group) compared with kidney donors who received standard-of-care (SOC) postoperative analgesia. The primary outcome was the mean total oral morphine equivalents (OMEs) administered following surgery. Results A total of 176 kidney donors were evaluated, 88 in each group. The mean OME administered in the CILA group was significantly higher than in the SOC group: 194.8 versus 133.5 mg ( P = 0.003). Mean total postoperative administration of acetaminophen was also increased in the CILA group: 3736.9 versus 2611.6 mg ( P = 0.0041). Mean length of stay following surgery was higher in the kidney donors who received CILA, whereas return to bowel function, time to ambulation, and pain scores were not significantly different. Conclusion and Relevance This report demonstrated that CILA is not an effective modality to reduce opioid utilization or improve recovery in kidney donors following laparoscopic nephrectomy.

A systematic review of opioid use and multimodal strategies in solid organ transplant recipients and living donors

“…All donor nephrectomy studies utilized an open or laparoscopic surgical technique. Nine studies evaluated the impact of intraoperative and/or postoperative ketorolac therapy 15,53–60 . Intraoperative and postoperative multimodal analgesic strategies including pregabalin/gabapentin, APAP, continuous infusion of anesthetics, TAP/ QL blocks, liposomal bupivacaine, avoidance of PCA, and auricular field nerve stimulation were used in 14 studies 15,16,53,55–58,61–67 .…”

“…Nine studies evaluated the impact of intraoperative and/or postoperative ketorolac therapy. 15,[53][54][55][56][57][58][59][60] Intraoperative and postoperative multimodal analgesic strategies including pregabalin/gabapentin, APAP, continuous infusion of anesthetics, TAP/ QL blocks, liposomal bupivacaine, avoidance of PCA, and auricular field nerve stimulation were used in 14 studies. 15,16,53,[55][56][57][58][61][62][63][64][65][66][67] Seven of 11 (64%) evaluations assessing PRPS demonstrated significantly lower pain scores when using these multimodal strategies.…”

“…15,[53][54][55][56][57][58][59][60] Intraoperative and postoperative multimodal analgesic strategies including pregabalin/gabapentin, APAP, continuous infusion of anesthetics, TAP/ QL blocks, liposomal bupivacaine, avoidance of PCA, and auricular field nerve stimulation were used in 14 studies. 15,16,53,[55][56][57][58][61][62][63][64][65][66][67] Seven of 11 (64%) evaluations assessing PRPS demonstrated significantly lower pain scores when using these multimodal strategies. 16,[55][56][57]62,63,65 Additionally, MME consumption was lower in nine out of 12 studies (75%) within 48 h of surgery.…”

“…15,16,53,[55][56][57][58][61][62][63][64][65][66][67] Seven of 11 (64%) evaluations assessing PRPS demonstrated significantly lower pain scores when using these multimodal strategies. 16,[55][56][57]62,63,65 Additionally, MME consumption was lower in nine out of 12 studies (75%) within 48 h of surgery. 15,16,55,58,61,[63][64][65]67 LOS was significantly shorter in seven out of 11 (64%) studies.…”