Category: Laparoscopic/ Robotic: Other

MP17-21 - Local Anaesthetic Infusion System, a novel technique in postoperative pain management after laparoscopic nephrectomy (LN) and Nephroureterectomy (LNU): An experience in Milton Keynes University Hospital; UK

Sat, Sep 22
10:00 AM - 12:00 PM

Introduction & Objective :

Postoperative pain management impacts directly on patient experience and length of hospital stay (LOS). Hitherto, opiate analgesia is the mainstay of pain control after LN and LNU. The morbidities associated with opiate use & abuse, are well published. Herein, we report on the successes achieved using a novel technique – Local anaesthetic infusion system, (LAIS); for post op pain management.  Our objectives are to assess the need for additional analgesia, to assess if LAIS is sufficient as a stand alone modality, and to report the effect of this technique on LOS.

Methods :

A retrospective study of patients who underwent LN and LNU from 2015 until April 2018 in MKUH was conducted using Electronic Data Managenent system (EDM). All patients had LAIS (ON-Q* pain relief system) with continuous infusion (bupivacaine 0.125% @ 5mls/hr) via a Y – cannula system. One branch inserted into the kidney extraction wound, and the other into the deep subcutaneous tissue in the area of the renal bed. Primary data included the quantity of ‘top up’, analgesia (morphine, tramadol, codeine and paracetamol) received in the first 24 – 48 hrs postoperatively, total quantity of analgesic prescription at discharge, and LOS.  Secondary outcomes were age, BMI, co-morbidities. Statistical analysis was by Mann-Whitney U test.

Results :

Thirty-six patients received LAIS post op after LN & LNU. Almost all patients (98%) received paracetamol routinely, “Top up” opiates (morphine, tramadol and codeine) was administered in 28 out of 36 patients (77.8%). It was mostly single drug, and only in combination in 10 (27.8%) patients.  Four patients received patient controlled analgesia overnight. Patients who received oral morphine only had 2 or 3 doses, maximum   (10 to 30 mg). Analgesia on discharge was paracetamol (98%), and only in a few cases, take home medicine included codeine or tramadol that patients were already on.  Median LOS was 2 days for LN, and 3 days for LNU. 16/36 (44.4%) patients went home after one day in hospital.   

Conclusions :

The avoidance of intravenous opiates and all its possible side effects is a great advantage for the use of LAIS. This novel technique we have shown to be a standalone alternative to post op pain relief after LN or LNU. We propose that LAIS should be considered as first choice as it has tremendously reduced LOS because of early patient re-animation, and reduced side effects. 

Rakan I. Odeh

Urology Registrar
Milton Keynes university hospital
Milton Keynes, England, United Kingdom

My name is Mr. Rakan I Odeh. I am a father of 3 beautiful kids. I work recently as a Urology registrar in Milton Keynes University Hospital (MKUH). I finihshed my pediatric urology fellowship traning from university of Toronto last year. Before that, I worked as a research fellow at Sickkids hospital in Toronto. I am interested in research activities and have published a considerable number of articles in renowned journals. The main bulk of my work is around pediatric urology. However, recently, I have started to to gain more interest into the adults world, hence I joined the department of Urology in MKUH. I hold the Arab borad of urology, Egyptian boardd of Urology, Membership of royla college of surgeons from England and 2 fellowships from university of Toronot. Also, I am doing a master of epidemiology in the university of Liverpool.
Thank you

Krishan Parekh

Urology Registrar
Milton Keynes, England, United Kingdom

Dubem E. O

Urology registrar
Milton Keynes, England, United Kingdom

Henry O. Andrews

Urology consultant
Milton Keynes, England, United Kingdom

Yan-Mei Goh