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Pain Management in Laparoscopic Donor Nephrectomy: A Review

DOI: 10.1155/2012/201852

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The management of postoperative pain is a key to patient early recovery, in particular, where the surgery was performed to benefit another human being. In recent years it has been recognized that multimodal analgesic methods are superior for postoperative pain relief. It is also imperative to remember that inadequately managed acute postoperative pain opens the doorway to possible suffering from chronic postoperative pain later. Although the laparoscopic donor nephrectomy has reduced the disincentives associated with open surgery, still significant percentage of donors suffers from postoperative pain. In the UK, patient-controlled analgesic system (PCAS) using morphine for postoperative pain relief is being used in majority of the transplant centres. Though opioids provide good analgesia, they are far from being an ideal analgesic due to their adverse effects. This paper pragmatically looks in depth on different modalities of pain management in patients undergoing laparoscopic live donor nephrectomy. 1. Introduction The donor nephrectomy is a procedure carried out to benefit another individual and in addition it can add a lot of disincentives to the donor. Subjecting a patient to an open operation leads to increased hospital inpatient stay and a much more painful large scar, thus not only discouraged the potential donors, but also it leads to increased morbidity for long time. This has stimulated the surgeons to come up with an alternative, the laparoscopic donor nephrectomies. The first laparoscopic live donor nephrectomy (LLDN) was performed by Ratner et al. [1] at the Johns Hopkins Bay view Medical Center, Baltimore, USA in February 1995. The donor was discharged on first postoperative day and returned to work 2 weeks later. This technique thus revolutionized the donor nephrectomy and also removed the added disincentives of open operation. LLDN is now the preferred method and gold standard operation for kidney donation. Although the LLDN is associated with the longer operation time, it has reduced morphine requirement, hospital stay, and postoperative complications with an early return to work [2]. Randomized controlled trials and systematic reviews confirmed that LLDN is safe and reduce the morbidity following the operation [2–4]. 2. Pain after LLDN Pain following the LLDN is multifactorial. Port pain, low abdominal incisions (to retrieve the kidney), pelvic organ nociception, diaphragmatic irritation (shoulder tip discomfort from residual pneumoperitoneum), urinary catheter discomfort add-up and contribute to the total pain experience. Several


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