A systematic review of living kidney donor enhanced recovery after surgery

Byrne, Matthew H V; Mehmood, Ahmed; Summers, Dominic M.; Hosgood, Sarah A.; Nicholson, Michael L.

doi:10.1111/ctr.14384

Cited by 8 publications

(4 citation statements)

References 51 publications

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“…A systematic review of ERAS protocols for living kidney donors presented a limited number of randomized controlled trials; most were retrospective cohort studies. 15 Although the positive benefits of ERAS were suggested in the review, only a few studies have investigated the effectiveness of the TAP block. One retrospective single-center study discovered that bupivacaine or liposomal bupivacaine TAP block reduced the postoperative opioid requirement after laparoscopic donor nephrectomy.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Postoperative Single-shot and Continuous Transverse Abdominis Plane Block Compared to Conventional Analgesia in Hand-assisted Laparoscopic Live-donor Nephrectomy

De Leon,

Alghannam,

Gul

et al. 2024

Transplantation Direct

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Background. Few studies have evaluated the efficacy of transverse abdominis plane (TAP) block in patients undergoing hand-assisted laparoscopic live-donor nephrectomy (HALN). We aimed to evaluate the analgesic effectiveness of TAP block as part of a multimodal pain management regimen in patients undergoing HALN. Methods. We retrospectively reviewed the medical records of living kidney donors at our center between June 2016 and February 2020. HALNs were performed via a transperitoneal approach through a suprapubic incision. Additional laparoscopic ports were used in the upper midabdomen. In consenting donors, TAP block was performed postoperatively under ultrasound guidance with either a single-shot or continuous infusion of long-acting local anesthetic (0.2%–0.5% ropivacaine). All the patients received postoperative around-the-clock ketorolac and acetaminophen. Results. Overall, 72 donors received the block (block group, 38 single-shot, 34 continuous), whereas 86 donors did not receive the block (control group). Baseline characteristics were comparable between the groups except for body weight (control: 71.8 ± 13.3 versus block: 77.8 ± 17.3 kg; P = 0.01) and intraoperative opioid dose (32.1 ± 9.6 versus 26.6 ± 10.7 morphine milligram equivalents; P < 0.001). After adjusting for baseline differences, postoperative opioid requirements were similar between the groups. When the baseline pain scale was adjusted for, there was no difference in the overall pain scale scores between the groups (P = 0.242). Subgroup analyses comparing single-shot or continuous TAP versus control did not show any differences. Conclusions. With the caveat of the retrospective nature of the study, the adjunctive effect of TAP block after transabdominal HALN was limited when other multimodal analgesia was used.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of Postoperative Single-shot and Continuous Transverse Abdominis Plane Block Compared to Conventional Analgesia in Hand-assisted Laparoscopic Live-donor Nephrectomy

De Leon,

Alghannam,

Gul

et al. 2024

Transplantation Direct

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“… 14 A systematic review of living donor nephrectomy showed that with laparoscopic procedures duration of stay was significantly reduced by 0.98 d in the ERAS group. Opiate requirement was reduced by 32.4 mg. 15 A meta-analysis showed that ERAS protocols result in reduced perioperative morbidity, shorter length of hospital stay and improved quality of life after living donor nephrectomy. 16 A study reviewed ERAS in kidney transplant recipients and was targeting a discharge home within 5 d of surgery.…”

Section: Discussionmentioning

confidence: 99%

Randomized Controlled Trial of Enhanced Recovery After Surgery Protocols in Live Kidney Donors: ERASKT Study

Saks,

Yoon,

Neiswinter

et al. 2024

Transplantation Direct

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Background: Enhanced recovery after surgery (ERAS) pathways represent a comprehensive approach to optimizing perioperative management and reducing hospital stay and cost. In living donor kidney transplantation, key impediments to postoperative discharge include pain, and opioid associated complications such as nausea, vomiting, and the return of gastrointestinal function. Methods: In this randomized controlled trial, living kidney transplantation donors were assigned to either the ERAS or control group. The ERAS group patients received 15 preoperative, 17 intraoperative, 19 postoperative element intervention. The control group received standard care. The ERAS group received a multimodal opioid sparing pain management including an intraoperative transverse abdominis plane block. Our primary outcome measure was postoperative opioid consumption. The secondary outcome measures were postoperative pain scores, first oral intake, and hospital length of stay. Results: There were no significant differences in demographics between the 2 groups. The ERAS group had a statistically significant reduction in total postoperative opioid consumption calculated in intravenous morphine equivalents (24.2 ± 20.2 versus 71 ± 39.5 mg, P < 0.01). Postoperative pain scores were significantly lower (P < 0.001) from 1 h postoperatively to 48 h. Surgical time was 45 min shorter (P = 0.037). Intraoperative PlasmaLyte administration was lower (PlasmaLyte: 1444 ± 907 versus 2168 ± 1347 mL, P = 0.049). Time to tolerating regular diet was shorter by 2 h (P < 0.008), and length of hospital stay was decreased by 10.1 h. Conclusions: The ERAS group experienced superior postoperative analgesia and a shorter length of hospital stay compared with controls.

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“…Отмечен достоверно менее выраженный послеоперационный болевой синдром и риски развития послеоперационной тошноты и рвоты без увеличения риска реадмисии. Аналогичные выводы получены в исследованиях, посвященных сравнению стандартного лечебного подхода и протокола ускоренного выздоровления при резекции почки [9] и при донорской нефрэктомии [17]. При этом размер удаляемого органа не коррелирует напрямую с общим суммарным размером доступа и объемом операционной травмы при применении современного инструментария, шейвера или фрагментации удаляемой почки [18].…”

Section: Discussionunclassified

Enchanced recovery after simple laparoscopic nephrectomy.

Vorobev¹,

Белобородов²,

Khovalyg³

et al. 2022

ECU

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Introduction. Simple nephrectomy is used for non-cancer diseases. That is, when the preservation of the kidney is unreasonable or dangerous. Since simple nephrectomy is a typical organ-delivering surgery, it is possible to optimize the perioperative period to reduce hospitalization and disability. The aim of the study was to compare the outcomes of simple laparoscopic nephrectomy using the enchanted recovery protocol and the standard approach. Materials and methods. A prospective randomized multicenter study included 27 patients with an established diagnosis of a non-functioning kidney, who were treated in the period 2018–2021 in urological hospitals in the city of Irkutsk. All patients were divided into two comparison groups: STANDART group (group I, n=14) and ENCHANCED RECOVERY group (group II, n=13). Results. Primary efficacy was comparable (p=0.892). It was found that the level of complications of class III according to Clavien-Dindo was statistically comparable in both groups (p>0.05), and the level of complications of class II was significantly higher in group I (p<0.05). When comparing the duration of hospitalization, there is a significantly (p <0.001) longer stay of patients in group I (9.5±2.2 days) compared to group II (1.0±0.0 days). Subjective satisfaction with the treatment performed (upon requesting a critical analysis of all possible complaints) was comparable and amounted to 57.1% for group I and 100% for group II (p=0.342). When conducting a logistic regression analysis for postoperative febrile condition, according to multivariate regression, the volume of intraoperative infusion was found to be a significant predictor (for each +1 ml; OR 0.003; 95% CI 0.0001; 0.005; p = 0.042); for postoperative pain syndrome >5 VAS points – increase in the size of the surgical approach per 1 mm (OR 0.14; 95% CI -0.01; 0.307; p = 0.077); for satisfaction with treatment, a negative effect of the duration of the postoperative stay was found (for each +1 day; OR -1.08; 95% CI -2.32; 0.15; p = 0.086). Conclusion. Simple laparoscopic nephrectomy under the enchanted recovery protocol allows achieving similar treatment results without increasing the risk of readmission or reoperation, but with the achievement of a better subjective and objective postoperative status of the patient.

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A systematic review of living kidney donor enhanced recovery after surgery

Cited by 8 publications

References 51 publications

Effectiveness of Postoperative Single-shot and Continuous Transverse Abdominis Plane Block Compared to Conventional Analgesia in Hand-assisted Laparoscopic Live-donor Nephrectomy

Effectiveness of Postoperative Single-shot and Continuous Transverse Abdominis Plane Block Compared to Conventional Analgesia in Hand-assisted Laparoscopic Live-donor Nephrectomy

Randomized Controlled Trial of Enhanced Recovery After Surgery Protocols in Live Kidney Donors: ERASKT Study

Enchanced recovery after simple laparoscopic nephrectomy.

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