An Evaluation of the Effect of Catheter-Directed Continuous Infusion of Local Anesthetic by Elastomeric Pump on Opioid Usage Following Donor Kidney Nephrectomy

Background Postoperative pain management following donor nephrectomy can prove challenging for immediate discharge on postoperative day 1 or 2. Although the standard for pain control is utilization of opioids, this increases the risk of postoperative ileus and, if continued inappropriately, increases excess opioids circulating in the community. One strategy that proposes to limit postoperative opioids in kidney donors is the continuous infusion of local anesthetics (CILA), though the effect on patient outcomes is unclear. Objective The purpose of this study was to evaluate the effectiveness of postoperative CILA to decrease opioid usage in kidney donors who undergo laparoscopic nephrectomy. Methods A retrospective analysis was conducted of kidney donors who underwent laparoscopic nephrectomy and received CILA (CILA group) compared with kidney donors who received standard-of-care (SOC) postoperative analgesia. The primary outcome was the mean total oral morphine equivalents (OMEs) administered following surgery. Results A total of 176 kidney donors were evaluated, 88 in each group. The mean OME administered in the CILA group was significantly higher than in the SOC group: 194.8 versus 133.5 mg ( P = 0.003). Mean total postoperative administration of acetaminophen was also increased in the CILA group: 3736.9 versus 2611.6 mg ( P = 0.0041). Mean length of stay following surgery was higher in the kidney donors who received CILA, whereas return to bowel function, time to ambulation, and pain scores were not significantly different. Conclusion and Relevance This report demonstrated that CILA is not an effective modality to reduce opioid utilization or improve recovery in kidney donors following laparoscopic nephrectomy.

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Addition of transversus abdominis plane block to patient controlled analgesia for laparoscopic high anterior resection improves analgesia, reduces opioid requirement and expedites recovery of bowel function

Annals of The Royal College of Surgeons of England ◽

10.1308/003588414x13946184900921 ◽

2014 ◽

Vol 96 (8) ◽

pp. 579-585 ◽

Cited By ~ 23

Author(s):

F Ris ◽

JM Findlay ◽

R Hompes ◽

A Rashid ◽

J Warwick ◽

...

Keyword(s):

Anterior Resection ◽

Enhanced Recovery ◽

Postoperative Pain Management ◽

Bowel Function ◽

Transversus Abdominis ◽

Opioid Use ◽

Patient Controlled Analgesia ◽

Transversus Abdominis Plane ◽

Pain Scores ◽

Intravenous Morphine

Introduction Opioid sparing in postoperative pain management appears key in colorectal enhanced recovery. Transversus abdominis plane (TAP) blocks offer such an effect. This study aimed to quantify this effect on pain, opioid use and recovery of bowel function after laparoscopic high anterior resection. Methods This was a retrospective analysis of prospective data on 68 patients. Patients received an epidural (n=24), intravenous morphine patient controlled analgesia (PCA, n=22) or TAP blocks plus PCA (n=22) determined by anaesthetist preference. Outcome measures were numerical pain scores (0–3), cumulative intravenous morphine dose and time to recovery of bowel function (passage of flatus or stool). Results There were no differences in patient characteristics, complications or extraction site. The TAP block group had lower pain scores (0.7 vs 1.36, p<0.001) and morphine requirements (8mg vs 15mg, p=0.01) than the group receiving PCA alone at 12 hours and 24 hours. Earlier passage of flatus (2.0 vs 2.7 vs 3.4 days, p=0.002), stool (3.1 vs 4.1 vs 5.5 days, p=0.04) and earlier discharge (4 vs 5 vs 6 days, p=0.02) were also seen. Conclusions Use of TAP blocks was found to reduce pain and morphine use compared with PCA, expedite recovery of bowel function compared with PCA and epidural, and expedite hospital discharge compared with epidural.

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DURATION OF SURGERY OF LAPAROSCOPIC NEPHRECTOMY -AN INITIAL EXPERIENCE IN IGMC, SHIMLA

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i3.1807 ◽

2021 ◽

Vol 5 (3) ◽

Author(s):

Bhartendu Nagesh ◽

D.K Verma ◽

R S Jhobta ◽

Sanjiv Sharma ◽

Mehar Chand

Keyword(s):

Operating Time ◽

Standard Of Care ◽

Laparoscopic Nephrectomy ◽

P Value ◽

Dense Adhesion ◽

Medical College ◽

Duration Of Surgery ◽

The Mean ◽

Gandhi Medical College ◽

Hydronephrotic Kidney

Background: Laparoscopic nephrectomy has been established as the standard of care for the management of benign non-functioning kidneys and has gained worldwide popularity over the past decade. Methods- This study was conducted in the Department of General surgery, Indira Gandhi medical college, Shimla on 20 selected patients of benign non functional kidney admitted for elective Laparoscopic Nephrectomy between July 2018 to June 2019 Results: In this study, the mean operating time in success full laparoscopic nephrectomies was 103.7 + 20.6 min in lap converted to open it was 165 .7 +26.99 min and in hand-assisted tame taken was 150 min which is statically not significant with p value =0.1317. Conclusion: The mean time taken for completion of laparoscopic nephrectomy in first 4 cases was 105 min and in next 4 cases was 108 min and in last 4 cases it was 97 min there was definitive learning curve as in last 4 cases operating time was less as compared to initial cases but operating time also depends on other factors like in hydronephrotic kidney due to well maintained plane dissection take less time ,but in pyonephrotic kidney ,tubercular kidney,previously intervension like PCN, there were dense adhesion resulting in more time for disection. Keywords: Laparoscopy, Nephrectomy, Duration of surgery

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Transmuscular quadratus lumborum block reduces opioid consumption and prolongs time to first opioid demand after laparoscopic nephrectomy

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2020-101745 ◽

2020 ◽

Vol 46 (1) ◽

pp. 18-24

Author(s):

Mette Dam ◽

Christian Hansen ◽

Troels Dirch Poulsen ◽

Nessn Htum Azawi ◽

Gunnar Hellmund Laier ◽

...

Keyword(s):

Intervention Group ◽

Oral Morphine ◽

Analgesic Efficacy ◽

Multimodal Analgesia ◽

Opioid Consumption ◽

Laparoscopic Nephrectomy ◽

Hospital Length Of Stay ◽

Control Group ◽

Pain Scores ◽

Quadratus Lumborum

BackgroundRobotic and hand-assisted laparoscopic nephrectomies are often associated with moderate to severe postoperative pain. The aim of the current study was to investigate the analgesic efficacy of the transmuscular quadratus lumborum (TQL) block for patients undergoing robotic or hand-assisted laparoscopic nephrectomy.MethodsFifty patients were included in this single-center study. All patients were scheduled for elective hand-assisted or robotic laparoscopic nephrectomy under general anesthesia. Preoperatively, patients were randomly allocated to TQL block bilaterally with ropivacaine 60 mL 0.375% or 60 mL saline and all patients received standard multimodal analgesia and intravenous patient-controlled analgesia. Primary outcome was postoperative oral morphine equivalent (OME) consumption 0–12 hours. Secondary outcomes were postoperative OME consumption up to 24 hours, pain scores, time to first opioid, nausea/vomiting, time to first ambulation and hospital length of stay (LOS).ResultsMean (95% CI) OME consumption was significantly lower in the intervention group at 12 hours after surgery 50 (28.5 to 71.5) mg versus control 87.5 (62.7 to 112.3) mg, p=0.02. At 24 hours, 69.4 (43.2 to 95.5) mg versus 127 (96.7 to 158.6) mg, p<0.01. Time to first opioid was significantly prolonged in the intervention group median (IQR) 4.4 (2.8–17.6) hours compared with 0.3 (0.1–1.0) hours in the control group, p<0.001. No significant intergroup differences were recorded for time to first ambulation, pain scores, nausea/vomiting nor for LOS.ConclusionPreoperative bilateral TQL block significantly reduced postoperative opioid consumption by 43% and significantly prolonged time to first opioid.Trial registration numberNCT03571490.

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Impact of Patient-Reported Allergies on Early Postoperative Opioid Use and Outcomes Following Ambulatory Hand Surgery

Hand ◽

10.1177/1558944720928483 ◽

2020 ◽

pp. 155894472092848 ◽

Cited By ~ 1

Author(s):

Francesca R. Coxe ◽

Lauren E. Wessel ◽

Claire I. Verret ◽

Jeffrey G. Stepan ◽

Joseph T. Nguyen ◽

...

Keyword(s):

Mental Health ◽

Oral Morphine ◽

Hand Surgery ◽

Postoperative Pain Management ◽

Opioid Use ◽

Entire Cohort ◽

Pain Scores ◽

Patient Reported ◽

Surgery Outcomes ◽

Total P

Background: Patient-reported allergies (PRAs) are associated with suboptimal orthopaedic surgery outcomes and may serve as a proxy for mental health. While mental health disorders are known risk factors for increased opioid use, less is known about how PRAs impact opioid use after orthopedic surgery. The purpose of this study was to investigate the association between PRAs and postoperative opioid use, pain, and satisfaction following hand surgery. Methods: Patients who underwent ambulatory hand surgery at a single institution from May 2017 to March 2019 were retrospectively reviewed. Various scores, including the Mindfulness Attention Awareness Scale (MAAS), were collected preoperatively. Postoperatively, patients completed a 2-week pain diary, satisfaction, and visual analog scale (VAS) pain scores. Opioid consumption was converted to oral morphine equivalents (OMEs) using standard conversions. Results: A total of 137 patients were divided into 2 groups based on presence (≥1) (n = 73) or absence (0) (n = 64) of PRAs. At baseline, the ≥ 1 PRA group had significantly higher female composition ( P < .001) and pain ( P < .001) and lower PROMIS mental health scores ( P = .044). Postoperative OME consumption averaged 42.5 (range 0-416) in the entire cohort, with no differences between groups. Among patients with ≥ 1 PRA, increasing number of allergies significantly correlated with increasing OME consumption across all time points (week 1, P = .016; week 2, P = .001; total, P = .005). Conclusions: The presence of PRAs did not impact postoperative narcotic usage, pain, or satisfaction. Increasing numbers of PRAs did, however, significantly correlate with higher narcotic use. These results may have implications for postoperative pain management in this population.

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Postoperative Patient-Controlled Analgesia in the Pediatric Cardiac Intensive Care Unit

Critical Care Nurse ◽

10.4037/ccn2017724 ◽

2017 ◽

Vol 37 (1) ◽

pp. 55-61 ◽

Cited By ~ 4

Author(s):

Hanna M. Epstein

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Postoperative Pain Management ◽

Older Children ◽

Patient Controlled Analgesia ◽

Pain Scores ◽

Dosing Regimens ◽

The Mean ◽

Cardiac Intensive Care ◽

Pain Management Strategy

BACKGROUNDHigh rates of uncontrolled pain in critically ill patients remain common. Patient-controlled analgesia is more effective than traditional intravenous as-needed dosing regimens for managing postoperative pain in older children and adults.OBJECTIVETo determine whether pain-related clinical outcomes in patients from age 10 years to adult following cardiac surgery are improved by using patient-controlled analgesia as a pain management strategy.METHODSUsing the plan-do-study-act method of quality improvement, a process was instituted to have both staff and patients’ families support the use of patient-controlled analgesia postoperatively as opposed to traditional pain control with as-needed analgesics. Use of as-needed medications and pain scores were retrospectively compared from before to after initiation of patient-controlled analgesia.RESULTSThe cumulative mean pain score from the time of extubation through the following 24 hours decreased from 4.14 (on a scale from 0 to 10) when strictly as-needed medications were used to 2.8 with patient-controlled analgesia. Further, the mean amount of opioid consumed decreased from 14.98 mg of morphine and 22.27 mg of oxycodone to 13.58 mg of morphine and 3.33 mg of oxycodone after implementation of patient-controlled analgesia.CONCLUSIONSStandardized use of patient-controlled analgesia for postoperative pain management in patients 10 years of age through adulthood is efficient and effective, as evidenced by less medication being consumed by patients and lower mean pain scores.

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Programmed Intermittent Boluses of Ropivacaine may Provide Superior Analgesia Compared with Continuous Infusion via Paravertebral Catheters following Thoracic Surgery

10.21203/rs.2.170/v1 ◽

2019 ◽

Author(s):

Bridget Bishop ◽

Luke Willshire ◽

Matthew Kilpin ◽

Chong Tan ◽

Laurence Weinberg ◽

...

Keyword(s):

Standard Deviation ◽

Thoracic Surgery ◽

Continuous Infusion ◽

Oral Morphine ◽

Intermittent Bolus ◽

Infusion Group ◽

Pain Scores ◽

Number Of Patients ◽

Oral Morphine Equivalent ◽

Morphine Equivalent

Abstract Background: Extrapleural paravertebral local anaesthetic catheters are an effective method of post-operative analgesia. We investigated if delivery of ropivacaine via programmed intermittent boluses provided superior analgesia to continuous infusion alone in patients after thoracic surgery. Methods: A single-centre, retrospective study of 84 adult patients who received an extrapleural paravertebral catheter following thoracic surgery was performed. Patients were stratified into two groups based on the percentage of the total daily ropivacaine dose delivered as a bolus: continuous infusion (< 10%; n = 29) and programmed intermittent bolus (> 10%; n = 55). Outcomes included opioid consumption, pain scores, and ketamine use. Results: Both groups were comparable. Mean (standard deviation) oral morphine equivalent daily dose consumption on day one, the primary outcome, was 173.4mg (139.7mg) for the continuous infusion group compared to 129.2mg (100.4mg) for the programmed intermittent bolus group, p = 0.10. On day two, the mean (standard deviation) was 149.8mg (130.2mg) and 102.5mg (94.6mg) respectively, p = 0.08. On day three this reached significance with 178.1mg (150.6mg) for the continuous infusion group compared to 80.1mg (74.6mg) for the programmed intermittent bolus group, p = 0.001. There was also a reduction in the number of patients requiring ketamine in the programmed intermittent bolus group on day two (p = 0.02) and day three (p = 0.04). There was no difference in pain scores. Conclusion: In patients receiving extrapleural paravertebral catheters after thoracic surgery, the delivery of ropivacaine via programmed intermittent boluses may provide superior analgesia compared to continuous infusion alone.

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BLOOD LOSS IN LAPAROSCOPIC NEPHRECTOMY -AN INITIAL EXPERIENCE IN IGMC, SHIMLA

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i3.1806 ◽

2021 ◽

Vol 5 (3) ◽

Author(s):

Bhartendu Nagesh ◽

D.K Verma ◽

R S Jhobta ◽

Sanjiv Sharma ◽

Mehar Chand

Keyword(s):

Blood Loss ◽

Standard Of Care ◽

Laparoscopic Nephrectomy ◽

P Value ◽

Dense Adhesion ◽

Medical College ◽

The Mean ◽

Gandhi Medical College ◽

End Stage ◽

Hydronephrotic Kidney

Background: Laparoscopic nephrectomy has been established as the standard of care for the management of benign non-functioning kidneys and has gained worldwide popularity over the past decade. Methods: This study was conducted in the Department of General surgery, Indira Gandhi medical college, Shimla on 20 selected patients of benign non functional kidney admitted for elective Laparoscopic Nephrectomy between July 2018 to June 2019 Results: Less than 100 ml of blood was lost in 3(15%) of the patient. 100 to 200 ml was lost in 9(45%) and in 3(15%) patients 200 to 300 ml blood was lost and 5 (25%) had blood loss more than 300 ml. The mean blood loss in successful laparoscopic nephrectomy was 129 +123 ml and in lap converted to open was 435.7 + 174.9 ml. which is significantly less in successful lap nephrectomy which is statistically significant with a p-value of o.oo3 Conclusion: Mean blood loss in laparoscopic nephrectomy was 145 +144 ml and in converted cases, it was 350+200 ml. mean blood loss in hydronephrotic kidney was 145+ 144.2 ml in pyonephrotic kidney 325+ 318 in end stage nephrolithiasis 350+ 200 ml .There was more blood loss in ESRD and pyonephrotic kidney due to dense adhesion whereas blood loss is less in hydronephrotic kidney due to well maintained plane for dissection . Keywords: Laparoscopy, Nephrectomy, Blood loss

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231: Laparoscopic Nephrectomy: Prolonged Diffusion of a Standard of Care

The Journal of Urology ◽

10.1016/s0022-5347(18)32498-4 ◽

2006 ◽

Vol 175 (4S) ◽

pp. 77-77

Author(s):

David C. Miller ◽

John T. Wei ◽

Brent K. Hollenbeck

Keyword(s):

Standard Of Care ◽

Laparoscopic Nephrectomy

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The analgesic efficacy of liposomal bupivacaine compared with bupivacaine hydrochloride for the prevention of postoperative pain: a systematic review and meta-analysis with trial sequential analysis

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2020-102427 ◽

2021 ◽

pp. rapm-2020-102427

Author(s):

Hanns-Christian Dinges ◽

Thomas Wiesmann ◽

Berit Otremba ◽

Hinnerk Wulf ◽

Leopold H Eberhart ◽

...

Keyword(s):

Systematic Review ◽

Postoperative Pain ◽

Pain Score ◽

Meta Analysis ◽

End Points ◽

Liposomal Bupivacaine ◽

Bupivacaine Hydrochloride ◽

Pain Scores ◽

Score Difference ◽

The Mean

Background/ImportanceLiposomal bupivacaine (LB) is a prolonged release formulation of conventional bupivacaine designed for prolonging local or peripheral regional single injection anesthesia. To this day, the benefit of the new substance on relevant end points is discussed controversial.ObjectiveThe objective was to determine whether there is a difference in postoperative pain scores and morphine consumption between patients treated with LB and bupivacaine hydrochloride in a systematic review and meta-analysis.Evidence reviewRandomized controlled trials (RCT) were identified in Embase, CENTRAL, MEDLINE and Web of Science up to May 2020. Risk of bias was assessed using Cochrane methodology. Primary end points were the mean pain score difference and the relative morphine equivalent (MEQ) consumption expressed as the ratio of means (ROM) 24 and 72 hours postoperatively.Findings23 RCTs including 1867 patients were eligible for meta-analysis. The mean pain score difference at 24 hours postoperatively was significantly lower in the LB group, at −0.37 (95% CI −0.56 to −0.19). The relative MEQ consumption after 24 hours was also significantly lower in the LB group, at 0.85 (0.82 to 0.89). At 72 hours, the pain score difference was not significant at −0.25 (−0.71 to 0.20) and the MEQ ratio was 0.85 (0.77 to 0.95).ConclusionThe beneficial effect on pain scores and opioid consumption was small but not clinically relevant, despite statistical significance. The effect was stable among all studies, indicating that it is independent of the application modality.

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Ultrasound-Guided Funicular Block: Ropivacaine Injection into the Tissue around the Spermatic Cord to Improve Analgesia during Orchiectomy in Dogs

Animals ◽

10.3390/ani11051275 ◽

2021 ◽

Vol 11 (5) ◽

pp. 1275

Author(s):

Vincenzo Cicirelli ◽

Pasquale Debidda ◽

Nicola Maggio ◽

Michele Caira ◽

Giovanni M. Lacalandra ◽

...

Keyword(s):

Postoperative Pain ◽

General Anaesthesia ◽

Spermatic Cord ◽

Postoperative Pain Management ◽

Control Group ◽

Ultrasound Guided ◽

Hemodynamic Stability ◽

Pain Scores ◽

Lower Pain ◽

Ropivacaine Hydrochloride

Orchiectomy is a common surgical procedure performed on small animals, and it requires postoperative pain management despite its relative simplicity. This study aimed to evaluate the hemodynamic stability, intraoperative administration of additional hypnotic and/or analgesic drugs, and postoperative pain scores following the combination of ultrasound-guided injection of ropivacaine hydrochloride into the spermatic cord and infiltration by the same anaesthetic of the incisional prescrotal line (ROP) or general anaesthesia. Dogs in the ROP group showed greater intraoperative hemodynamic stability and lower pain scores than the control group. The locoregional approach used in this study proved effective in minimising the responses to the surgical stimulus and ensured adequate analgesia intra- and postoperatively. This method, called ultrasound-guided funicular block, allows orchiectomy to be performed under deep sedation without general anaesthesia.

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