Evaluation of a multimodal analgesic regimen on outcomes following laparoscopic living donor nephrectomy

Abstract

Living donor nephrectomy (LDN) is a unique procedure in that its primary purpose is to provide physical benefit to another human being.Unfortunately for these altruistic patients, postoperative pain is a significant source of morbidity, resulting in prolonged length of stay (LOS), 1 chronic pain, 2,3 and hesitancy for future patients considering LDN. 4 Advances in surgical techniques, such as laparoscopic and robotic-assisted methods, have made considerable improvements 5,6 ; however, these techniques are still associated with significant postoperative pain. In addition to optimizing surgical techniques, many centers have also pursued multimodal pain management pathways to help continue to improve pain control and reduce complications. [7][8][9][10][11][12][13][14][15] These regimens typically include a combination of

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

“…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 . Seven of 11 (64%) evaluations assessing PRPS demonstrated significantly lower pain scores when using these multimodal strategies 16,55–57,62,63,65 .…”

“…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. 15,16,56,[58][59][60]63 No differences in safety outcomes were noted with regards to drowsiness, sedation, itching, or return to bowel function.…”

“…15,16,55,58,61,[63][64][65]67 LOS was significantly shorter in seven out of 11 (64%) studies. 15,16,56,[58][59][60]63 No differences in safety outcomes were noted with regards to drowsiness, sedation, itching, or return to bowel function. One study reported a significantly lower incidence of nausea and vomiting with opioid minimization regimens.…”

“…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.…”