Ashcraft E E, Baillie G M, Shafizadeh S F, McEvoy J R, Mohamed H K, Lin A, Baliga P K, Rogers J, Rajagopalan P R, Chavin K D
Department of Surgery, Medical University of South Carolina, Charleston 29425, USA.
Clin Transplant. 2001;15 Suppl 6:59-61. doi: 10.1034/j.1399-0012.2001.00011.x.
Fear of postoperative pain is a disincentive to living donor kidney transplantation. Laparoscopic donor nephrectomy (LDN) was developed in part to dispel this disincentive. The dramatic increase in the number of laparoscopic donor nephrectomies performed at our institution has been in part due to the reduction in postoperative pain as compared to traditional, open donor nephrectomy. We sought to further diminish the pain associated with this surgical technique. The purpose of this study was to compare the efficacy of three different postoperative pain management regimens after LDN. All living kidney donors performed laparoscopically (n=43) between September 1998 and April 2000 were included for analysis. Primary endpoints included postoperative narcotic requirements and length of stay. Narcotic usage was converted to morphine equivalents (ME) for comparison purposes. Patients received one of three pain control regimens (group 1: oral and intravenous narcotics; group II: oral and intravenous narcotics and the On-Q pump delivering a continuous infusion of subfascial bupivicaine 0.5%; and group III: oral and intravenous narcotics and subfascial bupivicaine 0.5% injection). Postoperative intravenous and oral narcotic use as measured in morphine equivalents was significantly less in group III versus groups I and II (group III: 28.7 ME versus group I: 40.2 ME, group II: 44.8 ME; P<0.05). Postoperative length of stay was also shorter for group III (1.8 days) versus group I (2.5 days) and group II (2.9 days). LDN has been shown to be a viable alternative to traditional open donor nephrectomy for living kidney donation. We observed that the use of combined oral and intravenous narcotics alone is associated with greater postoperative narcotic use and increased length of stay compared to either a combined oral and intravenous narcotics plus continuous or single injection subfascial administration of bupivicaine. The progressive modification of our analgesic regimen has resulted in decreased postoperative oral and intravenous narcotic use and a reduction in the length of stay. We recommend subfascial infiltration with bupivicaine to the three laparoscopic sites and the pfannenstiel incision at the conclusion of the procedure to reduce postoperative pain. We believe this improvement in postoperative pain management will continue to make LDN even more appealing to the potential living kidney donor.
对术后疼痛的恐惧是活体供肾肾移植的一个阻碍因素。腹腔镜供肾切除术（LDN）的发展部分是为了消除这一阻碍。我院进行的腹腔镜供肾切除术数量急剧增加，部分原因是与传统的开放性供肾切除术相比，术后疼痛有所减轻。我们试图进一步减轻与这种手术技术相关的疼痛。本研究的目的是比较LDN术后三种不同疼痛管理方案的疗效。纳入分析的所有患者均为1998年9月至2000年4月间接受腹腔镜手术的活体肾供者（n = 43）。主要终点包括术后麻醉药物需求量和住院时间。为便于比较，将麻醉药物用量换算为吗啡当量（ME）。患者接受三种疼痛控制方案之一（第1组：口服和静脉注射麻醉药；第II组：口服和静脉注射麻醉药以及使用On-Q泵持续输注0.5%的筋膜下布比卡因；第III组：口服和静脉注射麻醉药以及注射0.5%的筋膜下布比卡因）。与第I组和第II组相比，第III组术后以吗啡当量衡量的静脉和口服麻醉药使用量显著减少（第III组：28.7 ME，第I组：40.2 ME，第II组：44.8 ME；P<0.05）。第III组的术后住院时间（1.8天）也比第I组（2.5天）和第II组（2.9天）短。LDN已被证明是活体肾捐赠中传统开放性供肾切除术的一个可行替代方案。我们观察到，与口服和静脉注射麻醉药联合持续或单次注射筋膜下布比卡因相比，单纯使用口服和静脉注射麻醉药会导致术后麻醉药使用量增加和住院时间延长。我们镇痛方案的逐步改进已使术后口服和静脉注射麻醉药的使用量减少，住院时间缩短。我们建议在手术结束时，在三个腹腔镜手术部位以及耻骨联合上横切口处进行布比卡因的筋膜下浸润，以减轻术后疼痛。我们相信，术后疼痛管理的这种改善将继续使LDN对潜在的活体肾供者更具吸引力。
