Liposomal bupivacaine: Friend or foe in kidney donation?
Yang Y, Jantz A, Summers B, Patel A, Malinzak L, and Sulejmani N. Liposomal bupivacaine: Friend or foe in kidney donation? Am J Transplant 2018; 18:813-814.
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
Background: Pain following nephrectomy and concerns for opioid dependence are disincentives to living kidney donors (LKD). Efficacy of liposomal bupivacaine (LB) in post-operative care of LKD is variable. We evaluated the efficacy of a LBcontaining versus non-LB-containing pain control regimen in LKD. Methods: This was a retrospective review of LKD with complete electronic medical records. Primary endpoints were pain scores (PS) and change in PS at various time points (first PS, PS at 4, 8, 12, 16, 20, 24, 48 and 72 hours, last PS prior to discharge, and minimum and maximum PS). Secondary endpoints were opioid use in intravenous morphine equivalents (IV ME), length of stay (LOS), and adverse effects (AE) from opioid therapy. Results: Of 117 patients who met criteria, 62 patients received LB and 55 patients received a non-LB regimen. The reported PS and change in PS were comparable between groups except for minimum PS (p=0.02) (Tables 1 and 2). LB group received less oxycodone (10 mg IV ME vs. 15 mg IV ME; p=0.01) and hydrocodoneacetaminophen (6.7 mg IV ME vs. 13.3 mg IV ME, p=0.04) within the first 24 hours, while overall post-operative opioid use (30.8 mg IV ME vs. 24 mg IV ME; p=0.85) was no different. Median LOS and AEs were comparable. Table 1. Pain scores (Table presented) Conclusion: Post-operative pain outcomes were similar between LB and non-LB regimens, however significantly less opioid use was required in the first 24 hours in the LB group and may indicate a benefit with use of LB.