Kim Dong Hyuck, Jeon Young-Tae, Kim Hyung Geun, Oh Ah-Young, Ryu Jung-Hee, Bae Yu Kyung, Koo Chang-Hoon
Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Anesthesiology and Pain Medicine, Daegu Catholic University School of Medicine, Daegu, Korea.
World J Urol. 2023 May;41(5):1437-1444. doi: 10.1007/s00345-023-04374-3. Epub 2023 Apr 1.
It is unclear whether ketorolac-based patient-controlled analgesia (PCA) leads to acute kidney injury (AKI) after robot-assisted radical prostatectomy (RARP) in patients susceptible to AKI. We compared the postoperative AKI incidence with ketorolac- and fentanyl-based PCA after RARP.
After medical record review, eligible patients were divided in ketorolac and fentanyl groups. We conducted propensity score matching of 3239 patients and assigned 641 matched patients to each group, and compared the AKI incidence. We investigated potential risk factors for postoperative AKI, defined according to the Kidney Disease Improving Global Outcomes criteria. We collected preoperative data (age, height, weight, body mass index, American Society of Anesthesiologists physical status, medical history, creatinine level, estimated glomerular filtration rate, and hemoglobin level) and intraoperative data (maintenance anesthetics, surgery duration, anesthesia duration, crystalloid amount, colloid use, total amount of fluid administered, estimated blood loss, norepinephrine use, phenylephrine use, and PCA type).
The postoperative AKI incidence was significantly higher in the ketorolac than in the fentanyl group, both before (31.1% vs. 20.4%; p < 0.001) and after (31.5% vs. 22.6%; p < 0.001) matching. In the univariate analysis, ketorolac was significantly associated with postoperative AKI, both before (odds ratio [OR], 1.762; 95% confidence interval [CI], 1.475-2.105; p < 0.001) and after (OR, 1.574; 95% CI, 1.227-2.019; p < 0.001) matching. In the multivariate analysis, ketorolac-based PCA was independently associated with development of postoperative AKI in the matched groups (OR, 1.659; 95% CI, 1.283-2.147; p < 0.001).
Ketorolac-based PCA may increase postoperative AKI incidence after RARP; thus, renal function should be monitored in these patients.
对于易发生急性肾损伤（AKI）的患者，基于酮咯酸的患者自控镇痛（PCA）在机器人辅助根治性前列腺切除术（RARP）后是否会导致AKI尚不清楚。我们比较了RARP后基于酮咯酸和芬太尼的PCA的术后AKI发生率。
在查阅病历后，符合条件的患者被分为酮咯酸组和芬太尼组。我们对3239例患者进行倾向评分匹配，并将641例匹配患者分配到每组，比较AKI发生率。我们调查了根据改善全球肾脏病预后组织标准定义的术后AKI的潜在危险因素。我们收集了术前数据（年龄、身高、体重、体重指数、美国麻醉医师协会身体状况、病史、肌酐水平、估计肾小球滤过率和血红蛋白水平）和术中数据（维持麻醉剂、手术时间、麻醉时间、晶体液量、胶体使用量、液体总给药量、估计失血量、去甲肾上腺素使用量、去氧肾上腺素使用量和PCA类型）。
在匹配前（31.1%对20.4%；p＜0.001）和匹配后（31.5%对22.6%；p＜0.001），酮咯酸组的术后AKI发生率均显著高于芬太尼组。在单因素分析中，酮咯酸与术后AKI显著相关，在匹配前（比值比[OR]，1.762；95%置信区间[CI]，1.475 - 2.105；p＜0.001）和匹配后（OR，1.574；95%CI，1.227 - 2.019；p＜0.001）均如此。在多因素分析中，基于酮咯酸的PCA与匹配组术后AKI的发生独立相关（OR，1.659；95%CI，1.283 - 2.147；p＜0.001）。
基于酮咯酸的PCA可能会增加RARP后的术后AKI发生率；因此，应对这些患者的肾功能进行监测。
