Association of bowel rest and ketorolac analgesia with short hospital stay after laparoscopic donor nephrectomy.
OBJECTIVE
Because of the shortage of cadaveric kidneys for allograft transplantation, laparoscopic donor nephrectomy is becoming a more feasible option. Several large published series have reported hospital stays as long as 3.3 days. We report the positive effect of preoperative bowel rest and the use of ketorolac for postoperative analgesia on reducing the hospital stay after laparoscopic donor nephrectomy.


METHODS
From 2000 to 2005, 300 patients underwent laparoscopic donor nephrectomy at our institution by a single surgeon (P.G.S.). All patients underwent a bowel preparation regimen involving a clear liquid diet beginning 2 days before surgery. Furthermore, two bottles of magnesium citrate were taken orally the day before surgery, and all patients fasted after midnight before surgery. Patients self-administered one Fleets enema the evening before surgery. Postoperatively, the patients received ketorolac 30 mg intravenously every 6 hours for a maximum of 48 hours, with additional narcotics if necessary for analgesia.


RESULTS
The mean operative time was 180 +/- 55 minutes. Typically, patients were admitted the day of surgery and discharged the next postoperative day. The mean donor hospital stay was 1.1 days (range 1 to 3) with no readmissions. More than 97% of our patients were able to tolerate a clear liquid diet, pass flatus, and ambulate the day after surgery.


CONCLUSIONS
With implementation of a strict bowel preparation regimen and the use of ketorolac for postoperative analgesia, the donor length of stay was markedly improved from previously published results. We attribute the shorter hospital stay to the quicker return of bowel function and to less postoperative discomfort.
Breda
Alberto
A
Department of Urology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California 90095, USA. abreda@mednet.ucla.edu
Bui
Matthew H
MH
Liao
Joseph C
JC
Schulam
Peter G
PG
D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007422:Intestines / Q000187:drug effects / Q000502:physiology; D020910:Ketorolac / Q000009:adverse effects / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods; D010149:Postoperative Pain / Q000517:prevention & control*; D017060:Patient Satisfaction; D011300:Preoperative Care / Q000379:methods; D018570:Risk Assessment; D007507:Therapeutic Irrigation / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome
D020910:Ketorolac