Laparoscopic/ Robotic: Other
Moderated Poster Session
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
Saturday, September 22
10:00 AM - 12:00 PM
Location: Room 252B
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.
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.
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.
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.