Intraoperative incision combined with local anesthesia to improve postoperative pain after laparoscopic live donor nephrectomy / 国际外科学杂志

ABSTRACT

Objective:To evaluate the effect of intraoperative incision combined with local anesthesia in improving postoperative pain after retroperitoneal laparoscopic living donor nephrectomy.Methods:Using retrospective research methods, 28 donors who underwent hand-assisted retroperitoneal laparoscopic living donor nephrectomy at the Beijing Friendship Hospital, Capital Medical University from January 2018 to December 2020 were selected as the research group. Before the wound was sutured during the operation use 0.2% ropivacaine 20 mL+ 5 mg dexamethasone to block the transverse abdominis fascia and subcutaneously for infiltration anesthesia. The other 1∶1 matched 28 donors who had the same operation method but used on-demand systemic opioid analgesia after the operation as the control group. The demographic indicators (age, gender, body mass index, length of donor kidney), intraoperative conditions (intraoperative blood loss, operation time, warm ischemia time), 2, 12, 24, and 48 hours pain visual analogue scales(VAS) after operation were compared between the two groups of patients, postoperative systemic opioid demand rate, postoperative exhaust time, time to return to the ground, complication rate (postoperative bleeding, lung infection, lymphatic fistula, wound infection, intestinal obstruction), postoperative length of hospitalization and other information. Measurement data were expressed as mean±standard deviation ( Mean± SD), and independent sample t-test was used for comparison between groups; Chi-square test or Fisher exact probability method was used for comparison of count data between groups. Results:The pain VAS of the donors in the research group were significantly lower than those in the control group at 2 h, 12 h, 24 h, and 48 h after surgery (2 h 1.6±1.0 vs 3.9±1.1; 12 h 1.9±0.7 vs 3.1±1.0; 24 h 1.6±0.5 vs 2.9±0.8; 48 h 1.2±0.5 vs 2.3±0.8; P<0.05). The donors in the research group postoperative morphine requirement rate was also significantly lower than that of the control group (0 vs 21.4%), and the postoperative recovery time was significantly earlier than that of the control group [(25.7±4.5) h vs (30.6±6.6) h], the difference was statistically significant ( P<0.05). Lymphatic fistula was the main postoperative complication. There was no statistically significant difference between the research group and the control group (14.3% vs 25.0%) ( P>0.05). Conclusion:Intraoperative incision transversus abdominis fascia and subcutaneous combined local block anesthesia can effectively reduce the pain after laparoscopic donor nephrectomy, reduce the use of opioids, promote early postoperative activities of the donor, and will not increase postoperative complications incidence rate.