Retroperitoneoscopic living donor nephrectomy: a comparison with the open approach in respect of early postoperative pain management.
BACKGROUND
We retrospectively compared perioperative donor outcomes and early postoperative pain control after retroperitoneoscopic (RLDN) and standard open (OLDN) living donor nephrectomy.


METHODS
One hundred donors included fifty after RLDN (37 women/13 men) and 50 after OLDN (35 women/15 men) were retrospectively analyzed for basic analgesics, for opioid consumption, and for visual analog scale (VAS) to verify the experienced pain. The donors were questioned in the morning and evening of the first through fifth postoperative days.


RESULTS
The mean age of both groups was equal. The mean operating time was 149.7 +/- 48.2 minutes (60 to 270) for RLDN and 164.1 +/- 30.3 minutes (60 to 240) for OLDN (P = NS). The mean warm ischemia time was 120 +/- 36 seconds (50 to 240) and 114 +/- 31 seconds (60 to 190) for the RLDN and OLDN groups, respectively (P = NS). The mean evening VAS for RLDN versus OLDN on postoperative days 1 to 5 was: 2.1 versus 2.2 (P = NS), 0.9 versus 1.8 (P = .009), 0.5 versus 1.3 (P = .016), 0.1 versus 0.7 (P = .013), and 0.1 versus 0.7 (P = .013), respectively. In both groups there was a tendency toward a higher VAS score in the morning than in the evening. RLDN donors showed significantly earlier period free of pain (VAS = 0) than those after OLDN. There was a significant difference of being free from any opiate between both groups after surgery.


CONCLUSIONS
After RLDN donors experienced less postoperative pain than after OLDN over the early postoperative days. Therefore, postoperative regional anesthesia is not necessary for donors operated by a retroperitoneoscopic approach.
Bachmann
A
A
Department of Urology, Ludwig-Maximilians University of Munich, Munich, Germany. bachmanna@uhbs.ch
Giannini
O
O
Wolff
T
T
Dickenmann
M
M
Ruszat
R
R
Langer
I
I
Gürke
L
L
Gasser
T C
TC
Reich
O
O
Stief
C G
CG
Steiger
J
J
Sulser
T
T
D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D005260:Female; D006801:Humans; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D020858:Tissue and Organ Harvesting / Q000379:methods*
D000700:Analgesics