Can surgical approach affect postoperative analgesic requirements following laparoscopic nephrectomy: Transperitoneal versus retroperitoneal? A prospective clinical study

Meltem Savran-Karadeniz, Ilkay Kisa, Emine Aysu Salviz, Tulay Ozkan-Seyhan, Tzevat Tefik, Oner Sanli, Kamil Mehmet Tugrul

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: We performed this prospective clinical study to compare the postoperative recovery profile of our patients after transperitoneal (Group T) and retroperitoneal (Group R) laparoscopic nephrectomy approaches. Our primary hypothesis was that epidural analgesic consumption in Group R would be higher at the end of the first postoperative day. METHODS: Forty-four patients scheduled for elective transperitoneal or retroperitoneal laparoscopic nephrectomies were enrolled. All patients in both groups received epidural catheter and general anesthesia induction. At the end of the operation, patients were Arch. Esp. Urol. 2017; 70 (6): 603-611 603 given 10 ml 0.25% bupivacaine through epidural catheters and extubated. Postoperatively, patients started to receive a continuous infusion of 0.1% bupivacaine and 1μg/ml fentanyl 5ml/h with patient- controlled boluses of an additional 4ml through a patient controlled epidural analgesia (PCEA) device. They were prescribed IV tramadol 1mg/kg as a rescue analgesic (VAS≥4). Total analgesic consumption from PCEA devices and VAS scores during the first 24 postoperative hours were recorded as well as number of patients who required analgesic rescue. RESULTS: Forty patients completed the study, 20 in each group. Total epidural analgesic consumption during the first 12 hours were significantly higher in Group R (p<0.05). Basal, postoperative 30 min, 2, 6 hours VASrest, VASmobilization and 12 h VASmobilization scores, and number of patients who required rescue analgesic at 0, 30 min in Group R were significantly higher than Group T (p<0.05). CONCLUSION: Retroperitoneal laparoscopic nephrectomy was found to be more painful and patients in this group required more epidural and analgesic rescue during the first 12 postoperative hours.

Original languageEnglish (US)
Pages (from-to)603-611
Number of pages9
JournalArchivos Espanoles de Urologia
Volume70
Issue number6
StatePublished - Jul 1 2017

Fingerprint

Nephrectomy
Analgesics
Prospective Studies
Patient-Controlled Analgesia
Epidural Analgesia
Bupivacaine
Catheters
Clinical Studies
Tramadol
Equipment and Supplies
Epidural Anesthesia
Fentanyl
General Anesthesia

Keywords

  • Epidural
  • Laparoscopic nephrectomy
  • Postoperative analgesia
  • Retroperitoneal
  • Transperitoneal

ASJC Scopus subject areas

  • Urology

Cite this

Can surgical approach affect postoperative analgesic requirements following laparoscopic nephrectomy : Transperitoneal versus retroperitoneal? A prospective clinical study. / Savran-Karadeniz, Meltem; Kisa, Ilkay; Salviz, Emine Aysu; Ozkan-Seyhan, Tulay; Tefik, Tzevat; Sanli, Oner; Tugrul, Kamil Mehmet.

In: Archivos Espanoles de Urologia, Vol. 70, No. 6, 01.07.2017, p. 603-611.

Research output: Contribution to journalArticle

Savran-Karadeniz, Meltem ; Kisa, Ilkay ; Salviz, Emine Aysu ; Ozkan-Seyhan, Tulay ; Tefik, Tzevat ; Sanli, Oner ; Tugrul, Kamil Mehmet. / Can surgical approach affect postoperative analgesic requirements following laparoscopic nephrectomy : Transperitoneal versus retroperitoneal? A prospective clinical study. In: Archivos Espanoles de Urologia. 2017 ; Vol. 70, No. 6. pp. 603-611.
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abstract = "OBJECTIVES: We performed this prospective clinical study to compare the postoperative recovery profile of our patients after transperitoneal (Group T) and retroperitoneal (Group R) laparoscopic nephrectomy approaches. Our primary hypothesis was that epidural analgesic consumption in Group R would be higher at the end of the first postoperative day. METHODS: Forty-four patients scheduled for elective transperitoneal or retroperitoneal laparoscopic nephrectomies were enrolled. All patients in both groups received epidural catheter and general anesthesia induction. At the end of the operation, patients were Arch. Esp. Urol. 2017; 70 (6): 603-611 603 given 10 ml 0.25{\%} bupivacaine through epidural catheters and extubated. Postoperatively, patients started to receive a continuous infusion of 0.1{\%} bupivacaine and 1μg/ml fentanyl 5ml/h with patient- controlled boluses of an additional 4ml through a patient controlled epidural analgesia (PCEA) device. They were prescribed IV tramadol 1mg/kg as a rescue analgesic (VAS≥4). Total analgesic consumption from PCEA devices and VAS scores during the first 24 postoperative hours were recorded as well as number of patients who required analgesic rescue. RESULTS: Forty patients completed the study, 20 in each group. Total epidural analgesic consumption during the first 12 hours were significantly higher in Group R (p<0.05). Basal, postoperative 30 min, 2, 6 hours VASrest, VASmobilization and 12 h VASmobilization scores, and number of patients who required rescue analgesic at 0, 30 min in Group R were significantly higher than Group T (p<0.05). CONCLUSION: Retroperitoneal laparoscopic nephrectomy was found to be more painful and patients in this group required more epidural and analgesic rescue during the first 12 postoperative hours.",
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T1 - Can surgical approach affect postoperative analgesic requirements following laparoscopic nephrectomy

T2 - Transperitoneal versus retroperitoneal? A prospective clinical study

AU - Savran-Karadeniz, Meltem

AU - Kisa, Ilkay

AU - Salviz, Emine Aysu

AU - Ozkan-Seyhan, Tulay

AU - Tefik, Tzevat

AU - Sanli, Oner

AU - Tugrul, Kamil Mehmet

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N2 - OBJECTIVES: We performed this prospective clinical study to compare the postoperative recovery profile of our patients after transperitoneal (Group T) and retroperitoneal (Group R) laparoscopic nephrectomy approaches. Our primary hypothesis was that epidural analgesic consumption in Group R would be higher at the end of the first postoperative day. METHODS: Forty-four patients scheduled for elective transperitoneal or retroperitoneal laparoscopic nephrectomies were enrolled. All patients in both groups received epidural catheter and general anesthesia induction. At the end of the operation, patients were Arch. Esp. Urol. 2017; 70 (6): 603-611 603 given 10 ml 0.25% bupivacaine through epidural catheters and extubated. Postoperatively, patients started to receive a continuous infusion of 0.1% bupivacaine and 1μg/ml fentanyl 5ml/h with patient- controlled boluses of an additional 4ml through a patient controlled epidural analgesia (PCEA) device. They were prescribed IV tramadol 1mg/kg as a rescue analgesic (VAS≥4). Total analgesic consumption from PCEA devices and VAS scores during the first 24 postoperative hours were recorded as well as number of patients who required analgesic rescue. RESULTS: Forty patients completed the study, 20 in each group. Total epidural analgesic consumption during the first 12 hours were significantly higher in Group R (p<0.05). Basal, postoperative 30 min, 2, 6 hours VASrest, VASmobilization and 12 h VASmobilization scores, and number of patients who required rescue analgesic at 0, 30 min in Group R were significantly higher than Group T (p<0.05). CONCLUSION: Retroperitoneal laparoscopic nephrectomy was found to be more painful and patients in this group required more epidural and analgesic rescue during the first 12 postoperative hours.

AB - OBJECTIVES: We performed this prospective clinical study to compare the postoperative recovery profile of our patients after transperitoneal (Group T) and retroperitoneal (Group R) laparoscopic nephrectomy approaches. Our primary hypothesis was that epidural analgesic consumption in Group R would be higher at the end of the first postoperative day. METHODS: Forty-four patients scheduled for elective transperitoneal or retroperitoneal laparoscopic nephrectomies were enrolled. All patients in both groups received epidural catheter and general anesthesia induction. At the end of the operation, patients were Arch. Esp. Urol. 2017; 70 (6): 603-611 603 given 10 ml 0.25% bupivacaine through epidural catheters and extubated. Postoperatively, patients started to receive a continuous infusion of 0.1% bupivacaine and 1μg/ml fentanyl 5ml/h with patient- controlled boluses of an additional 4ml through a patient controlled epidural analgesia (PCEA) device. They were prescribed IV tramadol 1mg/kg as a rescue analgesic (VAS≥4). Total analgesic consumption from PCEA devices and VAS scores during the first 24 postoperative hours were recorded as well as number of patients who required analgesic rescue. RESULTS: Forty patients completed the study, 20 in each group. Total epidural analgesic consumption during the first 12 hours were significantly higher in Group R (p<0.05). Basal, postoperative 30 min, 2, 6 hours VASrest, VASmobilization and 12 h VASmobilization scores, and number of patients who required rescue analgesic at 0, 30 min in Group R were significantly higher than Group T (p<0.05). CONCLUSION: Retroperitoneal laparoscopic nephrectomy was found to be more painful and patients in this group required more epidural and analgesic rescue during the first 12 postoperative hours.

KW - Epidural

KW - Laparoscopic nephrectomy

KW - Postoperative analgesia

KW - Retroperitoneal

KW - Transperitoneal

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