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Titolo:
Further improvements in laparoscopic donor nephrectomy: decreased pain andaccelerated recovery
Autore:
Ashcraft, EE; Baillie, GM; Shafizadeh, SF; McEvoy, JR; Mohamed, HK; Lin, A; Baliga, PK; Rogers, J; Rajagopalan, PR; Chavin, KD;
Indirizzi:
Med Univ S Carolina, Dept Surg, Charleston, SC 29425 USA Med Univ S Carolina Charleston SC USA 29425 urg, Charleston, SC 29425 USA
Titolo Testata:
CLINICAL TRANSPLANTATION
, volume: 15, anno: 2001, supplemento:, 6
pagine: 59 - 61
SICI:
0902-0063(2001)15:<59:FIILDN>2.0.ZU;2-#
Fonte:
ISI
Lingua:
ENG
Keywords:
laparoscopic donor nephrectomy; postoperative pain; kidney transplantation; living donation; organ donation; length of stay;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
8
Recensione:
Indirizzi per estratti:
Indirizzo: Chavin, KD Med Univ S Carolina, Dept Surg, 96 Jonathan Lucas St,Suite 404,POB 250611,Charleston, SC 29425 USA Med Univ S Carolina 96 Jonathan Lucas St,Suite 404,POB 250611 Charleston SC USA 29425
Citazione:
E.E. Ashcraft et al., "Further improvements in laparoscopic donor nephrectomy: decreased pain andaccelerated recovery", CLIN TRANSP, 15, 2001, pp. 59-61

Abstract

Fear of postoperative pain is a disincentive to living donor kidney transplantation. Laparoscopic donor nephrectomy (LDN) was developed in part to dispel this disincentive. The dramatic increase in the number of laparoscopicdonor nephrectomies performed at our institution has been in part due to the reduction in postoperative pain as compared to traditional, open donor nephrectomy. We sought to further diminish the pain associated with this surgical technique. The purpose of this study was to compare the efficacy of three different postoperative pain management regimens after LDN. All livingkidney donors performed laparoscopically (n=43) between September 1998 andApril 2000 were included for analysis. Primary endpoints included postoperative narcotic requirements and length of stay. Narcotic usage was converted to morphine equivalents (ME) for comparison purposes. Patients received one of three pain control regimens (group I: oral and intravenous narcotics;group II: oral and intravenous narcotics and the On-Q (TM) pump deliveringa continuous infusion of subfascial bupivicaine 0.5%; and group III: oral and intravenous narcotics and subfascial bupivicaine 0.5% injection). Postoperative intravenous and oral narcotic use as measured in morphine equivalents was significantly less in group III versus groups I and II (group III: 28.7 ME versus group I: 40.2 ME, group III: 44.8 ME; P <0.05). Postoperative length of stay was also shorter for group III (1.8 days) versus group I (2.5 days) and group II (2.9 days). LDN has been shown to be a viable alternative to traditional open donor nephrectomy for living kidney donation. We observed that the use of combined oral and intravenous narcotics alone is associated with greater postoperative narcotic use and increased length of stay compared to either a combined oral and intravenous narcotics plus continuous or single injection subfascial administration of bupivicaine. The progressive modification of our analgesic regimen has resulted in decreased postoperative oral and intravenous narcotic use and a reduction in the lengthof stay. We recommend subfascial infiltration with bupivicaine to the three laparoscopic sites and the pfannenstiel incision at the conclusion of theprocedure to reduce postoperative pain. We believe this improvement in postoperative pain management will continue to make LDN even more appealing tothe potential living kidney donor.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 13/07/20 alle ore 07:09:54