Category: Laparoscopic/ Robotic: Other

MP17-14 - Living kidney donation: A comparison of three pain management regimens to reduce pain and opioid usage

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

Introduction & Objective : This study sought to determine if two standardized pain regimens offered improved safety and efficacy in laparoscopic donor nephrectomy (LDN) patients, when compared to the current pain regimen at our hospital.


Methods : Patients undergoing LDN at Sentara Norfolk General Hospital from 2016-2018 received one of three pain regimens: non-standardized pain regimen (Protocol I; retrospective review), standing acetaminophen + patient controlled anesthesia (PCA; Protocol II) or standing acetaminophen + ketorolac + PCA (Protocol III; prospective reviews). Dual primary endpoints were daily numeric pain scores and opioid use as measured by total morphine milligram-equivalents (MME).


Results :

59 patients were included in our study (Protocol I, n=20; Protocol II, n=20; Protocol III, n=19). Differences were noted in total MME when comparing Protocols I and II (P<0.05) and I and III (P<0.05), but not Protocols II and III (P=0.81). This difference translated into a significant benefit in percent of patients attaining “ideal pain control” when comparing Protocols I and II (P<0.05) and I and III (P=0.01), but not Protocols II and III (P=0.75). No difference was seen in return to bowel function, length of stay or 30-day readmission rate. Importantly, there was no difference in change in hemoglobin or creatinine clearance with the addition of the ketorolac.


Conclusions : Our study demonstrated a decrease in total MME used in LDN patients, which translated into improved pain control with the creation of two standardized pain control regimens; although, the addition of ketorolac offered no added benefit. Ultimately, long-term follow-up is needed for our study, as well as a larger, randomized, controlled study.

John Malcolm

Partner
Urology of Virginia / Eastern Virginia Medical School
Virginia Beach, Virginia

Brian Weiss

Norfolk, Virginia

Jesica Yau

Norfolk, Virginia

Laura Hulse

Norfolk, Virginia

Karl Neumann

Norfolk, Virginia

Amanda Ingemi

Norfolk, Virginia

Catherine Floroff

Norfolk, Virginia