Comparison of Acute and Chronic Pain after Open Nephrectomy versus Laparoscopic Nephrectomy

Abstract

We evaluated postoperative pain intensity and the incidence of chronic pain in patients with renal cell carcinoma undergoing laparoscopic or open radical nephrectomy.In this prospective study, 27 laparoscopic nephrectomy (Group LN) and 25 open nephrectomy (Group ON) patients were included. All patients received paracetamol infusion and intramuscular morphine 30 minutes before the end of the operation and intravenous patient controlled analgesia with morphine postoperatively. Data including patients’ demographics, visual analog scale (VAS) pain scores at postoperative 0.5, 1, 2, 4, 6, 12, and 24 hours, postoperative morphine consumption, analgesic demand, analgesic delivery, number of patients requiring rescue analgesics, side effects because of analgesic medications, and overall patient satisfaction were recorded and compared between the two groups. Two and 6 months after the operation, patients were evaluated for chronic postsurgical pain (CPSP).Postoperative average VAS pain scores were not different between the two groups. However, only at 2 hours postoperatively, pain score was significantly higher in Group ON than in Group LN. In both groups, the highest pain scores were recorded at 30 minutes and 1 hour after surgery. Ninety-six percent of group ON patients and 88% of group LN patients required additional analgesia in the early postoperative period (P = 0.33). Postoperative morphine consumption and analgesic demand were found to be similar between the two groups. CPSP at 2 months after surgery was observed in 4 out of 25 patients (16%) in the ON group and 3 out of 27 patients (11.1%) in the LN group (P = 0.6). Chronic pain at 6 months after surgery was observed in 1 ON patient (4%) and 1 LN patient (3.7%, P = 0.9).This study demonstrated that postoperative acute pain scores were not different after laparoscopic or open nephrectomy and patients undergoing laparoscopic or open nephrectomy were at equal risk of developing CPSP. Pain control should be carefully planned in order to reduce early postoperative pain and also potentially prevent CPSP.

Chronic pain after hand-assisted laparoscopic donor nephrectomy

“…Outcomes after laparoscopic nephrectomy are superior to those of open procurement in terms of blood loss, length of hospital stay and postoperative pain. However, a number of donor patients suffer from chronic pain and this poses an important barrier to living kidney donor programmes. Generally, kidney donation leads to an increase in perceived quality of life by living kidney donors, but chronic postoperative pain can, importantly, impair quality of life in these otherwise healthy people.…”

Chronic pain following laparoscopic living-donor nephrectomy: Prevalence and impact on quality of life

“…5,6 In addition the surgical technique can influence the development of CPSP, which is possibly related to the extent of intraoperative nerve injury and adhesion formation. 7 Another study by Alper et al 8 [11][12][13] To our knowledge, the impact of CPSP after LDN on HRQoL is unknown. 6 Gerbershagen and colleagues described an incidence of CPSP following open nephrectomy (for benign and malignant renal disease) of 28.6% and 8.6%, after 3 and 6 months, respectively.…”

“…6 Gerbershagen and colleagues described an incidence of CPSP following open nephrectomy (for benign and malignant renal disease) of 28.6% and 8.6%, after 3 and 6 months, respectively. 7 Another study by Alper et al 8 (usually with activity), and bulging at the incision. No studies have been performed on the development of CPSP following laparoscopic donor nephrectomy.…”

Chronic postoperative pain: recent findings in understanding and management

“…A 2016 nephrectomy study found no difference in the incidence of CPOP between a laparoscopic versus open approach 55 . In 2017, Capdevila et al .…”