Pain expectancy, prevalence, severity, and patterns following donor nephrectomy: Findings from the KDOC Study

Abstract

Postoperative pain is an outcome of importance to potential living kidney donors (LKDs). We prospectively characterized the prevalence, severity, and patterns of acute or chronic postoperative pain in 193 LKDs at six transplant programs. Three pain measurements were obtained from donors on postoperative Day (POD) 1, 3, 7, 14, 21, 28, 35, 41, 49, and 56. The median pain rating total was highest on POD1 and declined from each assessment to the next until reaching a median pain‐free score of 0 on POD49. In generalized linear mixed‐model analysis, the mean pain score decreased at each pain assessment compared to the POD3 assessment. Pre‐donation history of mood disorder (adjusted ratio of means [95% confidence interval (CI)]: 1.40 [0.99, 1.98]), reporting “severe” on any POD1 pain descriptors (adjusted ratio of means [95% CI]: 1.47 [1.12, 1.93]) and open nephrectomy (adjusted ratio of means [95% CI]: 2.61 [1.03, 6.62]) were associated with higher pain scores across time. Of the 179 LKDs who completed the final pain assessment, 74 (41%) met criteria for chronic postsurgical pain (CPSP), that is, any donation‐related pain on POD56. Study findings have potential implications for LKD education, surgical consent, postdonation care, and outcome measurements.

Comparison of the impact of propofol versus sevoflurane on early postoperative recovery in living donors after laparoscopic donor nephrectomy: a prospective randomized controlled study

“…Differences in underlying health conditions among study populations could confound comparison of postoperative recovery. In one recent study, higher level of physical activity in the pre-donation period was positively associated with the occurrence of chronic postsurgical pain, indicating that donors involved in vigorous physical activities may be more sensitive to postoperative pain or discomfort than stationary donors [ 40 ]. Additionally, pain threshold tends to be lower in healthy living donors than in patients undergoing a similar surgical procedure for health reasons, which could also have affected the results [ 41 ].…”

Perioperative factors associated with persistent postsurgical pain after hysterectomy, cesarean section, prostatectomy, and donor nephrectomy: a systematic review and meta-analysis

“…We were able to find only one study with extensive description of risk factors for PPSP after donor nephrectomy. 18 In this study, the authors have used both univariate as well as multivariable analysis of preoperative, perioperative, and postoperative risk factors of PPSP after donor nephrectomies. They report a history of mood disorders preoperatively, open nephrectomy (vs laparoscopic), and severe postoperative pain on postoperative day 1 as risk factors for PPSP at 8 weeks.…”

Comparison of the impact of propofol versus sevoflurane on early postoperative recovery in living donors after laparoscopic donor nephrectomy: a prospective randomized controlled study

“…Speci cally, the global QoR-40K score was 169 (162-179) in the IV propofol group and 142 (131-154) in the IH sevo urane group. Sub-dimension scores in the IV propofol group were 51 (47-54) for physical comfort, 41 (38)(39)(40)(41)(42)(43) for emotional state, 32 (29)(30)(31)(32)(33)(34)(35) for psychological support, 17 (13)(14)(15)(16)(17)(18)(19)(20) for physical independence and 31 (28)(29)(30)(31)(32)(33) for pain while these scores in the IH sevo urane group were 44 (38- The success rate of early ambulation was marginally higher in the IV propofol group (40 [100%] in the IV propofol group vs. 35 [87.5%] in the IH sevo urane group; p=0.055); however, all of the donors could ambulate on POD 1 ( Table 3). The numbers of steps during the early and late postoperative periods, and the total steps on POD 1, were signi cantly higher in the IV propofol group than in the IH sevo urane group.…”