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Postoperative analgesia in kidney transplantation

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Euroanaesthesia 2017

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Abstract

Background and Goal of Study: Postoperative pain in kidney transplantation may be severe and is usually undertreated. Systemic analgesia may be limited by renal impairment and altered pharmacokinetics. The goal of this study is to analyse postoperative analgesia regimen following renal transplantation. Materials and Methods: We performed a retrospective analysis of all patients submitted to kidney transplant (KTx) between December 2015 and November 2016, followed by Acute Pain Unit (APU) in our institution. Acute pain database was analysed. Statistical analysis was performed using SPSS Statistics® 24, percentages were used for categorical variables, mean with standard deviation (SD) or median with quartiles for numerical variables, depending on normality. The Qui-squared, T-Student and one-way ANOVA test or Spearman’s correlation were used as appropriate. Results and Discussion: From the 135 KTx, only 57 patients were followed by APU. The mean patient age was 49 years (SD 13), 71,9% were males. Intravenous opioid administration provided the mainstay of analgesia and paracetamol was used in all patients. 63,6% of patients used drug infusion balloon (DIB) and 36,4% patient-controlled analgesia (PCA). The opioids used were tramadol (63,3%), morphine (10,9%) and fentanyl (25,5%). DIB population used tramadol. PCA group used morphine or fentanyl (only bolus regimen). 86% of patients reported good pain control, 7% bad pain control and 5,3% sufficient pain control. In median, analgesia was used for 2 days (P25 1; P75 2). 7% of patients experienced adverse effects of analgesia. The age does not correlate with the type, duration and quality of analgesia, nor the type of opioid used (p=0,076) or adverse effects (p=0,996). The gender does not correlate to the type (p=0,731), duration (p=0,196) and quality of analgesia (p=0,244), nor the type of opioid used (p=0,397). The gender was related significantly to the presence of adverse effects (p=0,030). Quality of analgesia and the presence of adverse effects were not related to the type of analgesia or opioid. Conclusion(s): Current practice in our institution provides a good quality of analgesia, with minimal side effects and no harmful events. Presently, the use of PCA is being promoted, namely the use of fentanyl. PCA is an effective technique and due to negative feedback loop limits the adverse effects of opioids. An opportunity for improvement is the number of patients followed by APU.

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© Copyright 2020 Morressier GmbH.
All rights reserved.