Opioid Consumption After Laparoscopic Radical Nephrectomy in Early Postoperative Recovery Phase: A Retrospective Cohort Study.

Abstract

Laparoscopic radical nephrectomy is a relatively common surgical procedure in the treatment of renal cancer and kidney anomalies. Postoperative pain is a major challenge among these patients. Although alternate solutions to conduct analgesia have been researched lately, the pain management of nephrectomy patients still relies on opioids. Retrospective study with 226 patients undergoing elective laparoscopic radical nephrectomy. Epidural, intravenous and oral opioid consumption was recorded during the first 3 postoperative days and factors associated with increased amounts of administered opioids were assessed. Epidural analgesia was used in 188 (83.2%) of 226 patients and it was associated with increased opioid consumption in all 3 postoperative days. In multivariate analysis the other statistically significant risk factor for increased postoperative opioid consumption during the first 3 postoperative days was female gender, whereas higher BMI negatively correlated with high opioid consumption. Based on the results of this study, epidural analgesia was associated with increased opioid consumption after laparoscopic radical nephrectomy. With a more individualized pain management protocol it may be possible to decrease opioid consumption and thus the adverse effects of opioids in this patient group. In this retrospective study in postop nephrectomy cases, analgesia with or without appropriate level epidural infusions was delivered, and further pain or analgesia assessment was performed during the first 3 postoperative days. There was an association between epidural analgesia and with more total opioid equivalents administered, though plausible mechanistic explanations for this were unclear.