Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Clin Transplant. 2023 Oct;37(10):e15051. doi: 10.1111/ctr.15051. Epub 2023 Jun 19.
Enhanced recovery after surgery (ERAS) protocols have been associated with a reduction in opioid consumption and a hastening in recovery in abdominal surgery. However, their impact on laparoscopic donor nephrectomy (LDN) has not been fully elucidated. The aim of this study is to evaluate opioid consumption and other relevant outcome measures before and after implementation of a unique LDN ERAS protocol.
244 LDN patients were included in this retrospective cohort study. Forty-six underwent LDN prior to implementation of ERAS, whereas 198 patients received ERAS perioperative care. The primary outcome was daily oral morphine equivalent (OME) consumption averaged over the entire postoperative stay. Due to removal of preoperative oral morphine from the protocol partway through the study period, the ERAS group was further subdivided into morphine recipients and non-recipients for subgroup analysis. Secondary outcomes included the incidence of postoperative nausea and vomiting (PONV), length of stay, pain scores, and other relevant measures.
ERAS donors consumed significantly fewer average daily OMEs than Pre-ERAS donors (21.5 vs. 37.6, respectively; p < .0001). There were no statistically significant differences in OME consumption between morphine recipients and non-recipients. The ERAS group experienced less PONV (44.4% requiring one or more rescue antiemetic postoperatively, vs. 60.9% of Pre-ERAS donors; p = .008).
A protocol pairing lidocaine and ketamine with a comprehensive approach to preoperative PO intake, premedication, intraoperative fluid management and postoperative pain control is associated with reduced opioid consumption in LDN.
手术后加速康复（ERAS）方案与减少阿片类药物的消耗和加速腹部手术的康复有关。然而，它们对腹腔镜供肾切除术（LDN）的影响尚未完全阐明。本研究旨在评估实施独特的 LDN ERAS 方案前后阿片类药物的消耗和其他相关结果指标。
本回顾性队列研究纳入了 244 例 LDN 患者。46 例患者在 ERAS 实施前接受 LDN，198 例患者接受 ERAS 围手术期护理。主要结局是整个术后期间平均每天口服吗啡当量（OME）的消耗量。由于在研究期间，部分患者从方案中去除了术前口服吗啡，因此 ERAS 组进一步分为吗啡接受者和非接受者进行亚组分析。次要结局包括术后恶心和呕吐（PONV）的发生率、住院时间、疼痛评分和其他相关指标。
ERAS 供者消耗的平均每日 OME 明显少于 Pre-ERAS 供者（分别为 21.5 和 37.6；p < 0.0001）。吗啡接受者和非接受者之间的 OME 消耗量无统计学差异。ERAS 组 PONV 的发生率较低（44.4%需要术后使用一种或多种止吐药，而 Pre-ERAS 供者为 60.9%；p = 0.008）。
将利多卡因和氯胺酮与术前口服摄入、术前用药、术中液体管理和术后疼痛控制的综合方法相结合的方案与 LDN 中阿片类药物消耗的减少有关。
