Efficacy and safety of fast-track recovery strategy for patients undergoing laparoscopic nephrectomy.
OBJECTIVE
Factors that adversely affect early recovery after major laparoscopic procedures include ileus, pain, nausea, emesis, and fatigue. The objective of this randomized controlled study was to evaluate the impact of a multimodal fast-track (FT) rehabilitation program on recovery and length of hospital stay after laparoscopic nephrectomy.


METHODS
Thirty patients undergoing laparoscopic nephrectomy received either conventional care (control) or an FT recovery program. All patients received a standardized anesthetic technique and patient- controlled analgesia (morphine) for postoperative pain control. In the FT group, patients received premedication with rofecoxib and ranitidine, local anesthesia was administered at the ports and renal fosa during surgery, and postoperative non-opioid analgesic and gastrokinetic drugs were administered as part of an early enteral nutrition and mobilization program. During the postoperative period, pain and nausea were assessed at specific time intervals. In addition, recovery room and hospital discharge times, the need for rescue analgesics and antiemetics, patient satisfaction with pain management and quality of recovery, and side effects were recorded daily for 3 days after surgery. Patients were discharged home when they met previously defined discharge criteria.


RESULTS
The FT group was discharged earlier from the recovery room (74+/-23 v 103+/-47 minutes) and the hospital (41+/-11 v 59+/-11 hours). Pain and nausea scores were consistently lower in the FT group during the first 48 hours after surgery. In addition, the requirement for antiemetic rescue therapy during the first 24 hours was reduced in the FT group (15% v 58%). The FT group also received less morphine during the first 2 postoperative days (14+/-16 v 40+/-24 mg). Finally, patient satisfaction with postoperative pain control was significantly higher in the FT group.


CONCLUSIONS
A multimodal approach to minimizing postoperative side effects led to a reduced recovery room and hospital stay, as well as better pain control and patient satisfaction after laparoscopic nephrectomy.
Recart
Alejandro
A
Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, Dallas, Texas 75399-9068, USA.
Duchene
David
D
White
Paul F
PF
Thomas
Tojo
T
Johnson
D Brooke
DB
Cadeddu
Jeffrey A
JA
D000082:Acetaminophen / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use*; D000932:Antiemetics / Q000627:therapeutic use; D052246:Cyclooxygenase 2 Inhibitors / Q000627:therapeutic use; D005260:Female; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery; D007783:Lactones / Q000627:therapeutic use; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods / Q000534:rehabilitation*; D010149:Postoperative Pain / Q000188:drug therapy*; D011182:Postoperative Care / Q000379:methods*; D020250:Postoperative Nausea and Vomiting / Q000188:drug therapy; D011300:Preoperative Care / Q000379:methods*; D011899:Ranitidine / Q000627:therapeutic use; D013450:Sulfones / Q000627:therapeutic use
D000700:Analgesics; D000932:Antiemetics; D052246:Cyclooxygenase 2 Inhibitors; D006635:Histamine H2 Antagonists; D007783:Lactones; D013450:Sulfones; C116926:rofecoxib; D000082:Acetaminophen; D011899:Ranitidine