title: Postoperative Continuous Infusion of Local Anesthesia in Hand-Assisted Retroperitoneoscopic Living Donor Nephrectomy.
abstract: BACKGROUND
  Postoperative pain management in living kidney donor nephrectomy plays a key role in donor comfort and is important for the further acceptance of living kidney donation in times of organ shortage. Standard pain treatment (SPT) based on opioids is limited due to related side effects. Continuous infusion of local anesthesia (CILA) into the operative field is a promising alternative. The aim of this study was to evaluate whether CILA could reduce the dose of opioids in living kidney donors operated with hand-assisted retroperitoneoscopic donor nephrectomy (HARP).
  
  
  METHODS
  An observational study on 30 living donors was performed. The primary outcome was the difference of morphine equivalents (MEQ) administered between CILA and SPT.
  
  
  RESULTS
  On day 0 and 1, living donors with CILA received significant less MEQ compared to the SPT group, although on day 1 this effect was not statistically significant (day 0: 6.3 mg, interquartile range [IR] 4.2-11.2 vs 16.8 mg, IR 10.5-22.1, P = .009; day 1: 5.25 mg, IR 2.1-13.3 vs 13.3 mg, IR 6.7-23.8, P = .150). On days 2 and 3 there was no difference (day 2: 13.3 mg, IR 0.0-20.0 vs 13.3 mg, IR 6.7-13.3, P = .708; day 3: 13.3 mg, IR 0.0-26.7 vs 13.3 mg, IR 6.7-20, P = .825). Overall (days 0 to3) MEQ was also less for CILA without reaching statistical significance (39.6 mg, IR 10.9-70.5 vs 59.6 mg, IR 42.4-72.9, P = .187).
  
  
  CONCLUSIONS
  CILA seems to be an effective instrument for donor pain management in the first 24 hours after HARP. Its effect abates by 48 hours after surgery, especially if highly potent nonopioids are given.
authors: Department of General, Visceral and Cancer Surgery, Division of Transplantation Surgery, Transplant Center Cologne, University of Cologne, Germany. Electronic address: roger.wahba@uk-koeln.de.
authors: R
authors: R
authors: Wahba
authors: Department of General, Visceral and Cancer Surgery, Division of Transplantation Surgery, Transplant Center Cologne, University of Cologne, Germany.
authors: R
authors: R
authors: Kleinert
authors: Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Germany.
authors: M
authors: M
authors: Hellmich
authors: Department of Medicine, Renal Division, Transplant Center Cologne, University of Cologne, Germany.
authors: C
authors: C
authors: Kurschat
authors: Department of General, Visceral and Cancer Surgery, Division of Transplantation Surgery, Transplant Center Cologne, University of Cologne, Germany.
authors: N
authors: N
authors: Heiermann
authors: Department of General, Visceral and Cancer Surgery, Division of Transplantation Surgery, Transplant Center Cologne, University of Cologne, Germany.
authors: G
authors: G
authors: Dieplinger
authors: Department of Anesthesiology and Operative Intensive Care Medicine, University of Cologne, Germany.
authors: J
authors: J
authors: Löser
authors: Department of General, Visceral and Cancer Surgery, Division of Transplantation Surgery, Transplant Center Cologne, University of Cologne, Germany.
authors: D L
authors: DL
authors: Stippel
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007668:Kidney; D016030:Kidney Transplantation / Q000379:methods*; D010535:Laparoscopy; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods; D059408:Pain Management / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy*; D020858:Tissue and Organ Harvesting / Q000009:adverse effects*
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local