title: Ketorolac-based analgesia improves outcomes for living kidney donors.
abstract: BACKGROUND
  To reduce the morbidity of living kidney donors we introduced ketorolac-based analgesia for patients undergoing open donor nephrectomy in August 1999. There are no prior reports on the use of ketorolac for patients undergoing donor nephrectomy.
  
  
  METHODS
  We conducted a retrospective review of all 198 consecutive patients who underwent open living donor nephrectomy between January 1998 and July 2000 at our institution. We compared patients who underwent surgery before and after introduction of ketorolac-based analgesia.
  
  
  RESULTS
  The introduction of ketorolac-based analgesia resulted in a reduction in length of postoperative stay from 3.7+/-0.1 to 3.1+/-0.1 days (P<0.001). Patients who underwent surgery after ketorolac introduction required 58% less narcotics (P<0.001), recalled having less postoperative pain, and stopped taking pain medications sooner than patients before routine ketorolac use. Moreover, these patients drank 38% more liquids on the first postoperative day (P<0.001) and were able to resume a regular diet sooner than patients who were not managed with ketorolac. Patients who received ketorolac had a slightly lower creatinine clearance on the second postoperative day relative to patients who did not (66 vs. 72% of preoperative calculated creatinine clearance, P=0.05). However at a minimum of 3 months postoperatively, creatinine clearance did not differ between the two groups (70 vs. 73%, P=0.92). There were no differences in the rates of complications between the two groups.
  
  
  CONCLUSIONS
  The use of ketorolac to control postoperative pain for patients undergoing open donor nephrectomy reduced morbidity and was not associated with any effect on long-term renal function or increased risk of complications. This is the first study to demonstrate the safety of using ketorolac at the time of donor nephrectomy.
authors.affiliation: Department of Urology, UCLA School of Medicine, Los Angeles, CA 90095-1738, USA.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Freedland
authors.forename: Malou
authors.initials: M
authors.lastname: Blanco-Yarosh
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Sun
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Hale
authors.forename: David A
authors.initials: DA
authors.lastname: Elashoff
authors.forename: Mark S
authors.initials: MS
authors.lastname: Litwin
authors.forename: Robert B
authors.initials: RB
authors.lastname: Smith
authors.forename: Jacob
authors.initials: J
authors.lastname: Rajfer
authors.forename: H Albin
authors.initials: HA
authors.lastname: Gritsch
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D004064:Digestive System / Q000187:drug effects; D005260:Female; D006801:Humans; D020910:Ketorolac / Q000009:adverse effects / Q000627:therapeutic use*; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology; D016030:Kidney Transplantation; D007902:Length of Stay; D008297:Male; D010149:Postoperative Pain / Q000188:drug therapy*; D012189:Retrospective Studies; D014019:Tissue Donors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D020910:Ketorolac