Implementation of an opioid-sparing protocol utilizing liposomal bupivacaine and intravenous ketorolac for pain management after living kidney donation  

作　　者：Kevin Ly Antonio Di Carlo Sunil S Karhadkar Kenneth Chavin Francesca Graziano Kelley Maberry Nicole Sifontis Daohai Yu Xiaoning Lu Adam Diamond 

机构地区：[1]Department of Pharmacy,Temple University Hospital,Philadelphia,PA 19140,United States [2]Department of Surgery,Temple University Hospital,Philadelphia,PA 19140,United States [3]Temple University School of Pharmacy,Philadelphia,PA 19140,United States [4]Center for Biostatistics and Epidemiology,Department of Biomedical Education and Data Science,Lewis Katz School of Medicine at Temple University,Philadelphia,PA 19140,United States

出　　处：《World Journal of Transplantation》2025年第3期157-163,共7页世界移植杂志(英文)

摘　　要：BACKGROUND Opioids are commonly used for management of post-operative pain in living kidney donors.Reducing exposure to opioids is desirable to minimize risk of dependence and potential side effects such as nausea,vomiting,and constipation which may delay discharge.Liposomal bupivacaine,ketorolac,and scheduled acetaminophen have all demonstrated efficacy for management of post-operative pain in this population.AIM To assess the efficacy and safety of an opioid-sparing protocol utilizing a multimodal pain management approach in living kidney donors post-nephrectomy.METHODS Single-center,retrospective chart review study examining 52 living kidney donors(26 pre-protocol implementation,26 post-protocol implementation)from May 24th,2019 to September 27th,2023.Patients in the post-protocol group received intraoperative liposomal bupivacaine,hydromorphone PCA(until able to tolerate oral medications),15 mg of intravenous ketorolac every 6 hours for 3 doses,and scheduled oral acetaminophen,in addition to oxycodone as needed for moderate to severe pain.The primary endpoint was oral morphine equivalent(OME)use within 48 hours post-surgery.Secondary endpoints include average daily pain scale within 48 hours post-surgery,length of stay(LOS)(days),and incidence of new acute kidney injury(AKI)or gastrointestinal(GI)bleed during admission per provider.Differences between the pre-and post-protocol implementation groups were compared utilizing the exact Wilcoxon test for continuous variables and either the Fisher’s Exact orχ^(2) test for categorical variables.RESULTS Patients in the pre-protocol implementation group received more OME(mg)within 48 hours post-surgery when compared to the post-protocol group(median:84.5 vs 69.0).The median of total OME over the course of admission was numerically greater the pre-protocol group(105.0 vs 69.0),and was significantly more per LOS(41.3 vs 25.7,P=0.02).Average daily pain score was not statistically significantly different between the two groups on postoperative day 1(median:5.3 vs 4.4;P

关 键 词：OPIOID Pain management BUPIVACAINE KETOROLAC NEPHRECTOMY Living Donation Renal transplant 

分 类 号：R699.2[医药卫生—泌尿科学]