Retrospective Evaluation of Donor Pain and Pain Management After Laprascopic Nephrectomy

Gorevski, E.; Wead, Stephanie; Tevar, Amit D.; Succop, Paul; Volek, Peter; Martin-Boone, Jill E.

doi:10.1016/j.transproceed.2011.06.038

Cited by 9 publications

(11 citation statements)

References 19 publications

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“…However, our pain score results were lower than the pain score from a study by Gorevski and colleagues that compared i.v. PCA without any regional block to those using MMA [14]. Our results also showed the lower 24-h morphine consumptions in comparison to a study by Wang and colleagues on the laparoscopic nephrectomy patients using i.v PCA alone for the 24 h after surgery [14, 15].…”

Section: Discussionsupporting

confidence: 76%

“…Living laparoscopic nephrectomy donors suffer more pain and are associated with more morphine consumption than other laparoscopic nephrectomy patients [14, 15]. Our study was the first randomized controlled trial comparing the analgesic efficacy of bilateral transmuscular anterior QLB with continuous thoracic epidural analgesia following transperitoneal laparoscopic living donor nephrectomy.…”

Section: Discussionmentioning

confidence: 99%

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A randomized controlled trial on analgesic effect of repeated Quadratus Lumborum block versus continuous epidural analgesia following laparoscopic nephrectomy

et al. 2019

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BackgroundEpidural analgesia as the effective pain management for abdominal surgery has side effects such as paresthesia, hypotension, hematomas, and impaired motoric of lower limbs. The quadratus lumborum block (QLB) has potential as an abdominal truncal block, however, its analgesic efficacy has never been compared to epidural analgesia on laparoscopic nephrectomy. This prospective randomized controlled study compared the effectiveness of QLB with the epidural analgesia technique in relieving postoperative pain following transperitoneal laparoscopic nephrectomy.MethodsSixty-two patients underwent laparoscopic donor nephrectomy and were randomized to receive QLB (n = 31) or continuous epidural (n = 31). The QLB group received bilateral QLB using 0.25% bupivacaine and the epidural group received 6 ml/h of 0.25% bupivacaine for intraoperative analgesia. As postoperative analgesia, the QLB group received repeated bilateral QLB with the same dose and the epidural group received 6 ml/h of 0.125% bupivacaine for 24 h after surgery completion. The primary outcome was the 24-h cumulative morphine requirement after surgery. The secondary outcome was the postoperative pain scores. Sensory block coverage, hemodynamic changes, Bromage score, postoperative nausea-vomiting (PONV), paresthesia, and duration of urinary catheter usage were recorded and analyzed.ResultThe 24-h cumulative morphine requirement and pain scores after surgery were comparable between the QLB and epidural groups. The coverage of QLB was extended from T9 to L2 and the continuous epidural block was extended from T8 to L3 dermatomes. The mean arterial pressure (MAP) measured at 24 h after surgery was lower in the epidural group (p = 0.001). Bromage score, incidence of PONV, and paresthesia were not significantly different between the two groups. Duration of urinary catheter usage was shorter (p < 0.001) in the QLB group.ConclusionThe repeated QLB had a similar 24-h cumulative morphine requirement, comparable postoperative pain scores and sensory blockade, higher postoperative MAP, a similar degree of motoric block, no difference in the incidence of PONV and paresthesia, and shorter urinary catheter usage, compared to the continuous epidural analgesia following transperitoneal laparoscopic nephrectomy.Trial registrationClinicalTrial.gov NCT03520205 retrospectively registered on May 9th 2018.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

A randomized controlled trial on analgesic effect of repeated Quadratus Lumborum block versus continuous epidural analgesia following laparoscopic nephrectomy

et al. 2019

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“…However, other studies measuring pain on the day of surgery and consecutive postoperative days have demonstrated moderate pain after laparoscopic donor nephrectomy. 182,183 Thus, we considered the laparoscopic donor nephrectomy procedure in healthy donors as a suitable clinical pain model.…”

Section: Postsurgical Painmentioning

confidence: 99%

Pregabalin Has Analgesic, Ventilatory, and Cognitive Effects in Combination with Remifentanil

2016

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Background Pregabalin is widely used perioperatively. The authors explored the effects of pregabalin, remifentanil, and their combination on experimental pain, ventilatory, and cognitive function. Methods In a randomized, double-blinded crossover study, 12 volunteers received (1) pregabalin + placebo, (2) placebo + remifentanil, (3) pregabalin + remifentanil, and (4) placebo + placebo. Pregabalin 150 mg/placebo was administered twice orally. After baseline, remifentanil/placebo was given as effect-site target-controlled infusion (TCI): 0.6, 1.2, and 2.4 ng/ml. Pain during cold pressor test was scored on visual analog scale (0 to 100 mm). Ventilation was measured by spirometry and cognition tested with Color-Word Interference and Rapid Information Processing tests. Results Pain intensity after placebo was (mean) 72 mm (95% CI, 62 to 83). Pregabalin reduced pain score by −10 mm (−14 to −7, P < 0.001). Remifentanil had dose-dependent analgesic effect, reducing pain score by −47 mm (−54 to −39, P < 0.001) on highest TCI level, whereas pregabalin + remifentanil exerted additive effect, reducing pain score by −57 mm (−64 to −50, P < 0.001). Respiratory depression was potentiated by adding pregabalin to remifentanil; end-tidal carbon dioxide was 39.3 mmHg (37.2 to 41.3) with placebo, increased 1.8 mmHg (−0.9 to 4.6, P = 0.4) with pregabalin, 10.1 mmHg (4.9 to 15.4, P < 0.001) with remifentanil, and 16.4 mmHg (11.3 to 21.5, P < 0.001) with pregabalin + remifentanil on highest TCI level. The combination pregabalin + remifentanil, but not either drug alone, adversely affected all cognitive tests. Conclusions The combination of pregabalin and remifentanil had additive analgesic effects, pregabalin potentiated remifentanil ventilatory depression, and the combination adversely affected cognition. These results question the clinical benefit of the combination compared with higher doses of opioids.

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“…Although PCAS system is widely used, we do not know the best way of morphine administration. Some studies found PCAS as preferred [36, 37], but others could not replicate similar results [38, 39]. The patient satisfaction is found to be more with the use of PCAS [40] with less nursing time [41].…”

Section: Multimodal Approachmentioning

confidence: 99%

Pain Management in Laparoscopic Donor Nephrectomy: A Review

Thiyagarajan

Bagul

Nicholson

2012

Pain Research and Treatment

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The management of postoperative pain is a key to patient early recovery, in particular, where the surgery was performed to benefit another human being. In recent years it has been recognized that multimodal analgesic methods are superior for postoperative pain relief. It is also imperative to remember that inadequately managed acute postoperative pain opens the doorway to possible suffering from chronic postoperative pain later. Although the laparoscopic donor nephrectomy has reduced the disincentives associated with open surgery, still significant percentage of donors suffers from postoperative pain. In the UK, patient-controlled analgesic system (PCAS) using morphine for postoperative pain relief is being used in majority of the transplant centres. Though opioids provide good analgesia, they are far from being an ideal analgesic due to their adverse effects. This paper pragmatically looks in depth on different modalities of pain management in patients undergoing laparoscopic live donor nephrectomy.

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Retrospective Evaluation of Donor Pain and Pain Management After Laprascopic Nephrectomy

Cited by 9 publications

References 19 publications

A randomized controlled trial on analgesic effect of repeated Quadratus Lumborum block versus continuous epidural analgesia following laparoscopic nephrectomy

A randomized controlled trial on analgesic effect of repeated Quadratus Lumborum block versus continuous epidural analgesia following laparoscopic nephrectomy

Pregabalin Has Analgesic, Ventilatory, and Cognitive Effects in Combination with Remifentanil

Pain Management in Laparoscopic Donor Nephrectomy: A Review

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