Postoperative Continuous Infusion of Local Anesthesia in Hand-Assisted Retroperitoneoscopic Living Donor Nephrectomy

Wahba, Roger; Kleinert, Robert; Hellmich, Martin; Kurschat, Christine; Heiermann, N.; Dieplinger, Georg; Löser, Johannes; Stippel, Dirk L.

doi:10.1016/j.transproceed.2016.03.053

Cited by 3 publications

(5 citation statements)

References 12 publications

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“…The main finding of this investigation was that CILA had significantly increased opioid utilization after kidney donor laparoscopic nephrectomy, contrary to prior smaller investigations. 7,8,16 Kidney donors receiving CILA also had significantly longer hospital stays than those who received SOC. What caused this delay in discharge is not clear, but with a mean of 14 hours difference, this may have contributed to an additional day of inpatient admission.…”

Section: Discussionmentioning

confidence: 97%

“…15 The effectiveness of CILA is not clearly defined in less-invasive procedures. Wahba et al 8 aimed to look at the effectiveness of CILA at reducing opioids in living kidney donors undergoing hand-assisted retroperitoneoscopic donor nephrectomy compared with standard pain treatment with opioid and nonopioid analgesics. 8 The CILA group received ropivacaine 0.5% infused via 2 delivery catheters at 4 mL/h (2 mL/h through each catheter).…”

Section: Discussionmentioning

confidence: 99%

“…Wahba et al 8 aimed to look at the effectiveness of CILA at reducing opioids in living kidney donors undergoing hand-assisted retroperitoneoscopic donor nephrectomy compared with standard pain treatment with opioid and nonopioid analgesics. 8 The CILA group received ropivacaine 0.5% infused via 2 delivery catheters at 4 mL/h (2 mL/h through each catheter). During postoperative day 0, the patients who received CILA had a significantly lower amount of morphine equivalents administered, but this effect was lost after postoperative day 1, and the total morphine equivalents administered during the hospital stay was not significantly different.…”

Section: Discussionmentioning

confidence: 99%

“…During postoperative day 0, the patients who received CILA had a significantly lower amount of morphine equivalents administered, but this effect was lost after postoperative day 1, and the total morphine equivalents administered during the hospital stay was not significantly different. 8 Panaro et al 7 performed a retrospective, comparative analysis of 20 patients who underwent laparoscopic living donor nephrectomy; 10 received standard analgesia, and the other 10 received continuous wound infiltration with ropivacaine. 7 They found that the cumulative morphine IV administered at 24 and 48 hours after surgery was significantly decreased in the group that received ropivacaine.…”

Section: Discussionmentioning

confidence: 99%

“…The effect in minimally invasive nephrectomy is inconclusive and may have a detrimental effect on recovery of bowel function and length of stay. 7,8 Given the lack of larger studies investigating the role of CILA in minimally invasive donor nephrectomy, this evaluation seeks to elucidate the effectiveness of CILA on opioid utilization and postoperative recovery in kidney donor patients who have undergone laparoscopic nephrectomy.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

et al. 2021

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Perianesthetic Management of Laparoscopic Kidney Surgery

Nasrallah

Souki

2018

Curr Urol Rep

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A variety of laparoscopic approaches (transperitoneal, retroperitoneal, hand-assisted, robotic) are used with some having advantages over others. The kidneys are particularly sensitive to hemodynamic changes and pneumoperitoneum. Controversies in perioperative fluid administration exist. New modalities for postoperative pain control have been suggested. Laparoscopic kidney surgery is associated with multiple physiologic changes and adverse events but offers advantages of reduced postoperative pain, faster recovery, and shorter hospital stay. Understanding these physiologic changes and related anesthetic considerations is key for safe patient outcome.

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Peri-Incisional Infiltration and Intraperitoneal Instillation of Local Anesthetic for Reducing Pain After Laparoscopic Donor Nephrectomy: A Prospective, Randomized, Double-Blind Control Trial

Jang,

Chae,

Lee

et al. 2023

Transplantation Proceedings

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Postoperative Continuous Infusion of Local Anesthesia in Hand-Assisted Retroperitoneoscopic Living Donor Nephrectomy

Cited by 3 publications

References 12 publications

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

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

Perianesthetic Management of Laparoscopic Kidney Surgery

Peri-Incisional Infiltration and Intraperitoneal Instillation of Local Anesthetic for Reducing Pain After Laparoscopic Donor Nephrectomy: A Prospective, Randomized, Double-Blind Control Trial

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