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Literature search results

Search completed for:

Search required by: 31 October 2011

Search completed on: 18 October 2011

Search completed by: Richard Bridgen

Search details

Enhanced recovery for radical nephrectomy or partial nephrectomy patients

Resources searched

NHS Evidence; TRIP Database; Cochrane Library; BNI; CINAHL; EMBASE; MEDLINE; Google Scholar

Database search terms : partial adj2 nephrectom*; radical adj2 nephrectom*; PARTIAL NEPHRECTOMY; NEPHRECTOMY; kidney* adj2 resection; kidney adj2 remov*; “enhanced

recovery”; enhanc* adj2 recovery; ERAS; ERP; RECOVERY; convalescence; postoperative*; recovery; enhance*; “fast track surg*”; “accelerated recovery”; ARP; “accelerat* adj2 recovery; “fast track” adj2 surg*; accelerate*; “fast track”; fast* adj2 recovery; postoperative adj2 recovery; quick*; rapid*; speed*; fast*

Google search string : (nephrectomy OR nephrectomies) ("enhanced recovery" OR "accelerated recovery" OR ERAS OR ERP OR "fast track")

Summary

A fair amount of research on enhanced recovery and radical or partial nephrectomy. I’ve had to use a different set of resources, because of problems with NHS Evidence today, and the format of the results is therefore slightly different. It also means that the full-text links at the end of each article included within published research will only check to see whether full-text is available. Some will be available; some won’t – unfortunately you’re going to have to check each link.

Guidelines

None found.

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Evidence-based reviews

None found.

Published research

1. Laparoscopic nephrectomy vs. hand assisted laparoscopic nephrectomy: Comparing selection and outcomes.

Brett A., La-Touche S., Nikolaou Thomas J., Issa R., Corbishley C., Le Roux P., Rane A., Anderson C.J.

European Urology, Supplements. Conference: EAU 4th North Eastern European Meeting, NEEM Riga Latvia. Conference Start: 20100910 Conference End: 20100911. Conference Publication: (var.pagings). 9 (6) (pp 552), 2010. Date of Publication: September 2010.

[Journal: Conference Abstract]

AN: 70474260

Introduction & Objectives: Minimally invasive Nephrectomies can be done by pure (LN) or hand assisted (HALN) laparoscopy. Despite the tactile feedback in HAL facilitating the procedure it has not enjoyed wide acceptance. We compare feasibility and selection of these techniques. Material & Methods: From a prospective database, all LN and HAL cases were compared between 2002 and 2009.Majority of LN were done retroperitoneally and HALN transperitoneally. Results: 82 LN and 37 HALN were performed. Table 1 compares these 2 groups. (Table presented) Conclusions: HAL was selected for larger tumours and although blood loss was greater they had fewer intra-operative vascular and visceral injuries. Length of stay for HAL was slightly longer although in 2009 enhanced recovery programme has shortened stay in both. HAL is a comparable and safe alternative to LN and tactile feedback enhances confidence of undertaking more complex cases without compromising on safety.

Institution

(Brett, La-Touche, Nikolaou Thomas, Issa, Corbishley, Le Roux, Rane, Anderson) St George's Hospital, Dept. of Urology, London, United Kingdom

Publisher

Elsevier

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http://nhs4315978.resolver.library.nhs.uk?sid=OVID:embase&id=pmid:&id=doi:&issn=1569-9056&isbn=&volume=9&issue=6&spage=552&pages=552&date=2010&title=European+Urology%2C+Supplements&atitle=Laparoscopic+nephrectomy+vs.+hand+assisted+laparoscopic+nephrectomy%3A+Comparing+selection+and+outcomes&aulast=Brett&pid=%3Cauthor%3EBrett+A.%3BLa-Touche+S.%3BNikolaou+Thomas+J.%3BIssa+R.%3BCorbishley+C.%3BLe+Roux+P.%3BRane+A.%3BAnderson+C.J.%3C%2Fauthor%3E%3CAN%3E70474260%3C%2FAN%3E%3CDT%3EJournal%3A+Conference+Abstract%3C%2FDT%3E

2. Perioperative analgesia strategies in fast-track pediatric surgery of the kidney and renal pelvis: Lessons learned.

Dingemann J., Kuebler J.F., Wolters M., von Kampen M., Osthaus W.A., Ure B.M., Reismann M.

World Journal of Urology. 28 (2) (pp 215-219), 2010. Date of Publication: 2010.

[Journal: Article]

AN: 19565247

Purpose: Effective analgesia is essential for the success of fast-track (FT) pediatric surgery. Aim of the study was to achieve an optimal analgesia protocol for a comfortable postoperative course and early mobilization in children undergoing urological procedures. Methods: A prospective study of two analgesia concepts in a series of children undergoing laparoscopic pyeloplasty (LP) and nephrectomy (LN) was performed. Thirty-six consecutive patients received analgesia according to the protocol "Fast Track I" (FT I), 23 patients according to the modified analgesia protocol "Fast Track II" (FT II). Differences between the protocols were frequency of pain measurement, more frequent use of local anesthesia and higher dosage of Acetaminophen. End points were pain intensity, use of opioids and side effects. Data derived from the German reimbursement system (G-DRG) regarding lengths of

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hospital stay were compared. Results: On the day of operation (6:00 p. m.), pain scores of patients using FT II were significantly lower than those using the FT I protocol (1.51 +/- 0.4 FT II versus 3.8 +/- 0.4 FT I, p = 0.001). Pain scores still tended to be lower in the FT II group on the first postoperative day (8:00 a. m.), but from that point on, the difference was not significant (1.52 +/- 0.5 FT II versus 2.3 +/- 0.4 FT I, p = 0.186). Hospital stay was short, compared to the German average, in both groups. Conclusion: The modified analgesia protocol FT II leads to earlier and more effective pain reduction, lower use of opioids and fewer side effects than the previously used protocol FT I. Hence, modification of analgesia in pediatric urology is essential. Springer-Verlag 2009.

Institution

(Dingemann, Kuebler, Wolters, von Kampen, Ure, Reismann) Department of Pediatric Surgery, Hannover Medical School, 30625 Hannover, Germany (Osthaus) Department of Anesthesiology, Hannover Medical School, 30625 Hannover, Germany

Publisher

Springer Verlag (Tiergartenstrasse 17, Heidelberg D-69121, Germany)

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http://nhs4315978.resolver.library.nhs.uk?sid=OVID:embase&id=pmid:&id=doi:10.1007%2Fs00345-009-0442-9&issn=0724-4983&isbn=&volume=28&issue=2&spage=215&pages=215-219&date=2010&title=World+Journal+of+Urology&atitle=Perioperative+analgesia+strategies+in+fast-track+pediatric+surgery+of+the+kidney+and+renal+pelvis%3A+Lessons+learned&aulast=Dingemann&pid=%3Cauthor%3EDingemann+J.%3BKuebler+J.F.%3BWolters+M.%3Bvon+Kampen+M.%3BOsthaus+W.A.%3BUre+B.M.%3BReismann+M.%3C%2Fauthor%3E%3CAN%3E19565247%3C%2FAN%3E%3CDT%3EJournal%3A+Article%3C%2FDT%3E

3. Fast-track surgery in infants and children.

Reismann M., von Kampen M., Laupichler B., Suempelmann R., Schmidt A.I., Ure B.M.

Journal of Pediatric Surgery. 42 (1) (pp 234-238), 2007. Date of Publication: Jan 2007.

[Journal: Article]

AN: 2007012094

Background/Purpose: Fast-track surgery is not well established for infants and children. The aim of our prospective study was to investigate the feasibility of fast-track concepts for pediatric surgical procedures including laparoscopic techniques. Methods: Fast-track concepts, including immediate postoperative feeding, immediate mobilization, and morphine sparing pain treatment, were established for pyeloplasty, appendectomy, bowel anastomosis, fundoplication, hypospadia repair, and full/partial nephrectomy. All consecutive patients undergoing these procedures were prospectively investigated from June 2004 to June 2005. Patients with additional relevant diseases, reoperation, and perforated appendicitis were excluded from fast-track treatment. The length of hospital stay was compared with data derived from the German reimbursement system with German diagnosis-related groups for patients with a similar case mix index and hospitals with a similar structure. Results: Of a total of 159 patients (mean age, 5.8 +/- 5.3 years), 113 (71%) were finally treated according to the fast-track protocols. There were no complications associated with fast-track surgery. The intensity of pain during the immediate postoperative period was higher than 5 on a 10-point scale in children older than 4 years. Analgesia was excellent at all other time points. The mean hospital stay of fast-track patients was 2.3 +/- 1 days and was significantly shorter (P < .01) compared with German diagnosis-related group data for all procedures (pyeloplasty, 1.9 +/- 0.9 vs 12.2 +/- 0.2; nephrectomy, 1.9 +/- 1.0 vs 14.4 +/- 2.8; bowel anastomosis, 3.2 +/- 0.6 vs 12.9 +/- 2.4; fundoplication, 3.2 +/- 0.8 vs 15.2 +/- 4.2; appendectomy, 3.7 +/- 2.4 vs 6.3 +/- 1.8; hypospadia repair, 2.1 +/- 1 vs 8.4 +/- 1.4). Two readmissions were recorded. Ninety-six percent of patients and parents scored the fast-track concepts as excellent. Conclusion: The feasibility of fast-track concepts in children is excellent, with short duration of hospitalization and high comfort. 2007 Elsevier Inc. All rights reserved.

Institution

(Reismann, von Kampen, Laupichler, Schmidt, Ure) Department of Pediatric Surgery, Hanover Medical School, 30625 Hanover, Germany (Suempelmann) Department of Anesthesiology, Hanover Medical School, 30625 Hanover, Germany

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http://nhs4315978.resolver.library.nhs.uk?sid=OVID:embase&id=pmid:&id=doi:10.1016%2Fj.jpedsurg.2006.09.022&issn=0022-3468&isbn=&volume=42&issue=1&spage=234&pages=234-238&date=2007&title=Journal+of+Pediatric+Surgery&atitle=Fast-track+surgery+in+infants+and+children&aulast=Reismann&pid=%3Cauthor%3EReismann+M.%3Bvon+Kampen+M.%3BLaupichler+B.%3BSuempelmann+R.%3BSchmidt+A.I.%3BUre+B.M.%3C%2Fauthor%3E%3CAN%3E2007012094%3C%2FAN%3E%3CDT%3EJournal%3A+Article%3C%2FDT%3E

4. Evidence basis for regional anesthesia in multidisciplinary fast-track surgical care pathways.

Carli F., Kehlet H., Baldini G., Steel A., McRae K., Slinger P., Hemmerling T., Salinas F., Neal J.M.

Regional Anesthesia and Pain Medicine. 36 (1) (pp 63-72), 2011. Date of Publication: January-February 2011.

[Journal: Article]

AN: 2011009337

Fast-track programs have been developed with the aim to reduce perioperative surgical stress and facilitate patient's recovery after surgery. Potentially, regional anesthesia and analgesia techniques may offer physiological advantages to support fast-track methodologies in different type of surgeries. The aim of this article was to identify and discuss potential advantages offerred by regional anesthesia and analgesia techniques to fast-track programs.In the first section, the impact of regional anesthesia on the main elements of fast-track surgery is addressed. In the second section, procedure-specific fast-track programs for colorectal, hernia, esophageal, cardiac, vascular, and orthopedic surgeries are presented. For each, regional anesthesia and analgesia techniques more frequently used are discussed. Furthermore, clinical studies, which included regional techniques as elements of fast-track methodologies, were identified. The impact of epidural and paravertebral blockade, spinal analgesia, peripheral nerve blocks, and new regional anesthesia techniques on main procedure-specific postoperative outcomes is discussed. Finally, in the last section, implementations required to improve the role of regional anesthesia in the context of fast-track programs are suggested, and issues not yet addressed are presented. Copyright 2011 by American Society of Regional Anesthesia and Pain Medicine.

Institution

(Carli, Baldini, Hemmerling) Department of Anesthesia (D10-144), McGill University Health Center, Montreal General Hospital, 1650, Cedar Ave, Montreal, QC H3G 1A4, Canada (Kehlet) Section for Surgical Pathophysiology, Juliane Marie Center, Rigshospitalet, Copenhagen, Denmark

(Steel, McRae, Slinger) Department of Anesthesia, Toronto General Hospital, University of Toronto, ON, Canada

(Salinas, Neal) Department of Anesthesia, Virginia Mason Medical Center, Seattle, WA, United States

Publisher

Lippincott Williams and Wilkins (530 Walnut Street, Philadelphia PA 19106-3621, United States)

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http://nhs4315978.resolver.library.nhs.uk?sid=OVID:embase&id=pmid:&id=doi:10.1097%2FAAP.0b013e31820307f7&issn=1098-7339&isbn=&volume=36&issue=1&spage=63&pages=63-72&date=2011&title=Regional+Anesthesia+and+Pain+Medicine&atitle=Evidence+basis+for+regional+anesthesia+in+multidisciplinary+fast-track+surgical+care+pathways&aulast=Carli&pid=%3Cauthor%3ECarli+F.%3BKehlet+H.%3BBaldini+G.%3BSteel+A.%3BMcRae+K.%3BSlinger+P.%3BHemmerling+T.%3BSalinas+F.%3BNeal+J.M.%3C%2Fauthor%3E%3CAN%3E2011009337%3C%2FAN%3E%3CDT%3EJournal%3A+Article%3C%2FDT%3E

5. Nephrectomy in Denmark 2002-2005. <Nefrektomi i Danmark 2002-2005.>

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Firoozfard B., Christensen T.H., Bendixen A., Nordling J., Sundhedsstyrelsen H.K.

Ugeskrift for Laeger. 168 (15-16) (pp 1526-1528), 2006. Date of Publication: 10 Apr 2006.

[Journal: Article]

AN: 2006207553

Introduction: Implementation of principles of fast-track surgery as well as laparoscopy may decrease hospital stay after nephrectomy to about 2-4 days. The aim of this study was to analyse the incidence, use of laparoscopic vs. open nephrectomy, hospital stay, morbidity and mortality in Danish hospitals within the period 2002-2005. Methods: Extraction of information from the National Patient Register (LPR) and discharge notes from Jan. 1 2002 to Dec. 31 2004. Results: In the 3-year period, 1968 nephrectomies were performed in a total of 45 departments, decreasing to 29 departments in 2004. Five departments performed > 100 operations during the 3 years, 10 departments performed between 50-100 operations and 30 departments < 50 operations during the 3 years. The average length of hospital stay (primary and readmission) was 9.1 days. The total mortality rate was 2.2%; lower (1.5%) in departments with high activity vs. departments with low activity (4.3%, p < 0.01). Laparoscopic surgery was performed in 11 departments with a hospital stay of 5.2 vs. 9.5 days and with fewer surgical and medical complications and mortality (0.4% vs. 2.5%), compared with open operation. Conclusion: The organisation and results after nephrectomy are not optimal on a nationwide basis. This precludes further optimisation of the early perioperative results, including use of the laparoscopic approach combined with the principles of fast-track surgery. It is suggested that nephrectomy in the future is performed in fewer departments to fulfil these needs.

Institution

(Firoozfard, Christensen, Bendixen, Nordling, Sundhedsstyrelsen) Center for Evaluering og Medicinsk Teknologivurdering (CEMTV), H:S Rigshospitalet, Urologisk Afdeling og Juliane Marie Centret (Bendixen) Center for Evaluering og Medicinsk Teknologivurdering (CEMTV), Sundhedsstyrelsen, DK-2300 Kobenhavn S

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http://nhs4315978.resolver.library.nhs.uk?sid=OVID:embase&id=pmid:&id=doi:&issn=0041-5782&isbn=&volume=168&issue=15-16&spage=1526&pages=1526-1528&date=2006&title=Ugeskrift+for+Laeger&atitle=Nefrektomi+i+Danmark+2002-2005&aulast=Firoozfard&pid=%3Cauthor%3EFiroozfard+B.%3BChristensen+T.H.%3BBendixen+A.%3BNordling+J.%3BSundhedsstyrelsen+H.K.%3C%2Fauthor%3E%3CAN%3E2006207553%3C%2FAN%3E%3CDT%3EJournal%3A+Article%3C%2FDT%3E

6. Continuous infusion of local anesthesia after living donor nephrectomy: a comparative analysis.

Panaro F. Gheza F. Piardi T. Woehl Jaegle ML. Audet M. Cantu M. Cinqualbre J. Wolf P.

Transplantation Proceedings. 43(4):985-7, 2011 May.

[Journal Article]

UI: 21620032

INTRODUCTION: Today local anesthetic wound infiltration is widely recognized as a useful adjunct in a multimodality approach to postoperative pain management. The effectiveness of continuous wound infusion of ropivacaine for postoperative pain relief after laparoscopic living donor nephrectomy was analyzed in this retrospective, comparative analysis.

METHODS: Twenty patients undergoing living donor nephrectomy were divided into two groups: standard analgesic therapy (n=10) and ropivacaine continuous infusion group (n = 10).

RESULTS: We observed a significant difference in term of visual analogue scale scores, use of morphine, hospital stay, and bowel recovery in favor of the ropivacaine group. The cost analysis demonstrated an overall savings of 985 Euros/patient.

DISCUSSION: Surgical wound infusion with ropivacaine was safe and seemed to improve pain relief and accelerate recovery and discharge, reducing the overall costs of care. Postoperative pain control in the donor is of primary importance for better patient compliance and greater perceived quality of health care service. Copyright Copyright 2011 Elsevier Inc. All rights reserved.

Stage

6

MEDLINE

Authors Full Name

Panaro, F. Gheza, F. Piardi, T. Woehl Jaegle, M L. Audet, M. Cantu, M. Cinqualbre, J. Wolf, P.

Institution

Centre de Chirurgie Viscerale et de Transplantation-Hopital de Hautepierre, Hopitaux Universitaires de Strasbourg-Universite Louis Pasteur, Strasbourg, France.

Date Created

20110530

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http://nhs4315978.resolver.library.nhs.uk?sid=OVID:medline&id=pmid:21620032&id=doi:&issn=0041-1345&isbn=&volume=43&issue=4&spage=985&pages=985-7&date=2011&title=Transplantation+Proceedings&atitle=Continuous+infusion+of+local+anesthesia+after+living+donor+nephrectomy%3A+a+comparative+analysis.&aulast=Panaro&pid=%3Cauthor%3EPanaro+F%3BGheza+F%3BPiardi+T%3BWoehl+Jaegle+ML%3BAudet+M%3BCantu+M%3BCinqualbre+J%3BWolf+P%3C%2Fauthor%3E%3CAN%3E21620032%3C%2FAN%3E%3CDT%3EJournal+Article%3C%2FDT%3E

7. Perioperative analgesia strategies in fast-track pediatric surgery of the kidney and renal pelvis: lessons learned.

Dingemann J. Kuebler JF. Wolters M. von Kampen M. Osthaus WA. Ure BM. Reismann M.

World Journal of Urology. 28(2):215-9, 2010 Apr.

[Journal Article]

UI: 19565247

PURPOSE: Effective analgesia is essential for the success of fast-track (FT) pediatric surgery. Aim of the study was to achieve an optimal analgesia protocol for a comfortable postoperative course and early mobilization in children undergoing urological procedures.

METHODS: A prospective study of two analgesia concepts in a series of children undergoing laparoscopic pyeloplasty (LP) and nephrectomy (LN) was performed. Thirty-six consecutive patients received analgesia according to the protocol "Fast Track I" (FT I), 23 patients according to the modified analgesia protocol "Fast Track II" (FT II). Differences between the protocols were frequency of pain measurement, more frequent use of local anesthesia and higher dosage of Acetaminophen. End points were pain intensity, use of opioids and side effects. Data derived from the German reimbursement system (G-DRG) regarding lengths of hospital stay were compared.

RESULTS: On the day of operation (6:00 p.m.), pain scores of patients using FT II were significantly lower than those using the FT I protocol (1.51 + or - 0.4 FT II versus 3.8 + or - 0.4 FT I, p = 0.001). Pain scores still tended to be lower in the FT II group on the first postoperative day (8:00 a.m.), but from that point on, the difference was not significant (1.52 + or - 0.5 FT II versus 2.3 + or - 0.4 FT I, p = 0.186). Hospital stay was short, compared to the German average, in both groups.

CONCLUSION: The modified analgesia protocol FT II leads to earlier and more effective pain reduction, lower use of opioids and fewer side effects than the previously used protocol FT I. Hence, modification of analgesia in pediatric urology is essential.

Stage

MEDLINE

Authors Full Name

Dingemann, Jens. Kuebler, Joachim F. Wolters, Mathias. von Kampen, Mirja. Osthaus, Wilhelm A. Ure, Benno M. Reismann, Marc.

Institution

Department of Pediatric Surgery, Hannover Medical School, 30625 Hannover, Germany. dingemann.jens@mh-hannover.de

Date Created

20100408

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http://nhs4315978.resolver.library.nhs.uk?sid=OVID:medline&id=pmid:19565247&id=doi:&issn=0724-4983&isbn=&volume=28&issue=2&spage=215&pages=215-9&date=2010&title=World+Journal+of+Urology&atitle=Perioperative+analgesia+strategies+in+fast-track+pediatric+surgery+of+the+kidney+and+renal+pelvis%3A+lessons+learned.&aulast=Dingemann&pid=%3Cauthor%3EDingemann+J%3BKuebler+JF%3BWolters+M%3Bvon+Kampen+M%3BOsthaus+WA%3BUre+BM%3BReismann+M%3C%2Fauthor%3E%3CAN%3E19565247%3C%2FAN%3E%3CDT%3EJournal+Article%3C%2FDT%3E

8. Fast-track surgery in infants and children.

Reismann M. von Kampen M. Laupichler B. Suempelmann R. Schmidt AI. Ure BM.

Journal of Pediatric Surgery. 42(1):234-8, 2007 Jan.

[Journal Article]

UI: 17208572

BACKGROUND/PURPOSE: Fast-track surgery is not well established for infants and children. The aim of our prospective study was to investigate the feasibility of fast-track concepts for pediatric surgical procedures including laparoscopic techniques.

METHODS: Fast-track concepts, including immediate postoperative feeding, immediate mobilization, and morphine sparing pain treatment, were established for pyeloplasty, appendectomy, bowel anastomosis, fundoplication, hypospadia repair, and full/partial nephrectomy. All consecutive patients undergoing these procedures were prospectively investigated from June 2004 to June 2005. Patients with additional relevant diseases, reoperation, and perforated appendicitis were excluded from fast-track treatment. The length of hospital stay was compared with data derived from the German reimbursement system with German diagnosis-related groups for patients with a similar case mix index and hospitals with a similar structure.

RESULTS: Of a total of 159 patients (mean age, 5.8 +/- 5.3 years), 113 (71%) were finally treated according to the fast-track protocols. There were no complications associated with fast-track surgery. The intensity of pain during the immediate postoperative period was higher than 5 on a 10-point scale in children older than 4 years. Analgesia was excellent at all other time points. The mean hospital stay of fast-track patients was 2.3 +/- 1 days and was significantly shorter (P < .01) compared with German diagnosis-related group data for all procedures (pyeloplasty, 1.9 +/- 0.9 vs 12.2 +/- 0.2; nephrectomy, 1.9 +/- 1.0 vs 14.4 +/- 2.8; bowel anastomosis, 3.2 +/- 0.6 vs 12.9 +/- 2.4; fundoplication, 3.2 +/- 0.8 vs 15.2 +/- 4.2; appendectomy, 3.7 +/- 2.4 vs 6.3 +/- 1.8; hypospadia repair, 2.1 +/- 1 vs 8.4 +/- 1.4). Two readmissions were recorded. Ninety-six percent of patients and parents scored the fast-track concepts as excellent.

CONCLUSION: The feasibility of fast-track concepts in children is excellent, with short duration of hospitalization and high comfort.

Stage

MEDLINE

Authors Full Name

Reismann, Marc. von Kampen, Mirja. Laupichler, Birgit. Suempelmann, Robert. Schmidt, Annika I. Ure, Benno M.

Institution

Department of Pediatric Surgery, Hanover Medical School, 30625 Hanover, Germany.

Date Created

20070108

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http://nhs4315978.resolver.library.nhs.uk?sid=OVID:medline&id=pmid:17208572&id=doi:&issn=0022-3468&isbn=&volume=42&issue=1&spage=234&pages=234-8&date=2007&title=Journal+of+Pediatric+Surgery&atitle=Fast-track+surgery+in+infants+and+children.&aulast=Reismann&pid=%3Cauthor%3EReismann+M%3Bvon+Kampen+M%3BLaupichler+B%3BSuempelmann+R%3BSchmidt+AI%3BUre+BM%3C%2Fauthor%3E%3CAN%3E17208572%3C%2FAN%3E%3CDT%3EJournal+Article%3C%2FDT%3E

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9. Efficacy and safety of fast-track recovery strategy for patients undergoing laparoscopic nephrectomy.

Recart A. Duchene D. White PF. Thomas T. Johnson DB. Cadeddu JA.

Journal of Endourology. 19(10):1165-9, 2005 Dec.

[Journal Article. Randomized Controlled Trial. Research Support, Non-U.S. Gov't]

UI: 16359206

BACKGROUND AND PURPOSE: Factors that adversely affect early recovery after major laparoscopic procedures include ileus, pain, nausea, emesis, and fatigue. The objective of this randomized controlled study was to evaluate the impact of a multimodal fast-track (FT) rehabilitation program on recovery and length of hospital stay after laparoscopic nephrectomy.

PATIENTS AND METHODS: Thirty patients undergoing laparoscopic nephrectomy received either conventional care (control) or an FT recovery program. All patients received a standardized anesthetic technique and patient- controlled analgesia (morphine) for postoperative pain control. In the FT group, patients received premedication with rofecoxib and ranitidine, local anesthesia was administered at the ports and renal fosa during surgery, and postoperative non-opioid analgesic and gastrokinetic drugs were administered as part of an early enteral nutrition and mobilization program. During the postoperative period, pain and nausea were assessed at specific time intervals. In addition, recovery room and hospital discharge times, the need for rescue analgesics and antiemetics, patient satisfaction with pain management and quality of recovery, and side effects were recorded daily for 3 days after surgery. Patients were discharged home when they met previously defined discharge criteria.

RESULTS: The FT group was discharged earlier from the recovery room (74+/-23 v 103+/-47 minutes) and the hospital (41+/-11 v 59+/-11 hours). Pain and nausea scores were consistently lower in the FT group during the first 48 hours after surgery. In addition, the requirement for antiemetic rescue therapy during the first 24 hours was reduced in the FT group (15% v 58%). The FT group also received less morphine during the first 2 postoperative days (14+/-16 v 40+/-24 mg). Finally, patient satisfaction with postoperative pain control was significantly higher in the FT group.

CONCLUSIONS: A multimodal approach to minimizing postoperative side effects led to a reduced recovery room and hospital stay, as well as better pain control and patient satisfaction after laparoscopic nephrectomy.

Stage

MEDLINE

Authors Full Name

Recart, Alejandro. Duchene, David. White, Paul F. Thomas, Tojo. Johnson, D Brooke. Cadeddu, Jeffrey A.

Institution

Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, Dallas, Texas 75399-9068, USA.

Date Created

20051219

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http://nhs4315978.resolver.library.nhs.uk?sid=OVID:medline&id=pmid:16359206&id=doi:&issn=0892-7790&isbn=&volume=19&issue=10&spage=1165&pages=1165-9&date=2005&title=Journal+of+Endourology&atitle=Efficacy+and+safety+of+fast-track+recovery+strategy+for+patients+undergoing+laparoscopic+nephrectomy.&aulast=Recart&pid=%3Cauthor%3ERecart+A%3BDuchene+D%3BWhite+PF%3BThomas+T%3BJohnson+DB%3BCadeddu+JA%3C%2Fauthor%3E%3CAN%3E16359206%3C%2FAN%3E%3CDT%3EJournal+Article%3C%2FDT%3E

10. Fast-track open transperitoneal nephrectomy.

Firoozfard B. Christensen T. Kristensen JK. Mogensen S. Kehlet H.

Scandinavian Journal of Urology & Nephrology. 37(4):305-8, 2003.

[Evaluation Studies. Journal Article. Research Support, Non-U.S. Gov't]

UI: 12944188

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OBJECTIVE: Hospital stay after open transperitoneal nephrectomy is usually 5-10 days, the limiting factors being pain, ileus, stress-induced organ dysfunction and fatigue. Recent studies have shown that aggressive multimodal rehabilitation may improve recovery and shorten hospitalization after other abdominal procedures. We therefore studied the effect of a multimodal rehabilitation regimen in patients undergoing open transperitoneal nephrectomy.

MATERIAL AND METHODS: A total of 25 consecutive patients scheduled for elective transperitoneal nephrectomy were studied after the introduction of a multimodal rehabilitation regimen (continuous epidural analgesia, enforced mobilization and oral nutrition and revision of the transurethral catheterization and drain regimen) and compared with 50 consecutive patients treated before the introduction of this regimen.

RESULTS: The multimodal rehabilitation regimen decreased hospital stay from 8 to 4 days (p < 0.001) with mobilization for approximately 6 h on the first postoperative day and 8 h on the second and third days. Use of a drain was shorter with the multimodal regimen (1 vs 4 days; p < 0.001), as was transurethral catheterization (1 vs 5 days; p < 0.001). "Medical" 30-day morbidity was low (6-8%) in both groups.

CONCLUSION: Our results suggest that a multimodal rehabilitation regimen with optimized pain relief, enforced mobilization, early oral nutrition and short-term transurethral catheterization and drain placement may reduce hospital stay after open transperitoneal nephrectomy.

Stage

MEDLINE

Authors Full Name

Firoozfard, Behroz. Christensen, Tom. Kristensen, Jorgen Kvist. Mogensen, Susanne. Kehlet, Henrik.

Institution

Department of Urology, Rigshospitalet University of Copenhagen, Denmark. Firoozfard@get2net.dk

Date Created

20030828

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11. Further improvements in laparoscopic donor nephrectomy: decreased pain and accelerated recovery.

Ashcraft EE. Baillie GM. Shafizadeh SF. McEvoy JR. Mohamed HK. Lin A. Baliga PK. Rogers J. Rajagopalan PR. Chavin KD.

Clinical Transplantation. 15 Suppl 6:59-61, 2001.

[Journal Article]

UI: 11903389

Fear of postoperative pain is a disincentive to living donor kidney transplantation. Laparoscopic donor nephrectomy (LDN) was developed in part to dispel this disincentive. The dramatic increase in the number of laparoscopic donor nephrectomies performed at our institution has been in part due to the reduction in postoperative pain as compared to traditional, open donor nephrectomy. We sought to further diminish the pain associated with this surgical technique. The purpose of this study was to compare the efficacy of three different postoperative pain management regimens after LDN. All living kidney donors performed laparoscopically (n=43) between September 1998 and April 2000 were included for analysis. Primary endpoints included postoperative narcotic requirements and length of stay. Narcotic usage was converted to morphine equivalents (ME) for comparison purposes. Patients received one of three pain control regimens (group 1: oral and intravenous

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narcotics; group II: oral and intravenous narcotics and the On-Q pump delivering a continuous infusion of subfascial bupivicaine 0.5%; and group III: oral and intravenous narcotics and subfascial bupivicaine 0.5% injection). Postoperative intravenous and oral narcotic use as measured in morphine equivalents was significantly less in group III versus groups I and II (group III: 28.7 ME versus group I: 40.2 ME, group II: 44.8 ME; P<0.05). Postoperative length of stay was also shorter for group III (1.8 days) versus group I (2.5 days) and group II (2.9 days). LDN has been shown to be a viable alternative to traditional open donor nephrectomy for living kidney donation. We observed that the use of combined oral and intravenous narcotics alone is associated with greater postoperative narcotic use and increased length of stay compared to either a combined oral and intravenous narcotics plus continuous or single injection subfascial administration of bupivicaine. The progressive modification of our analgesic regimen has resulted in decreased postoperative oral and intravenous narcotic use and a reduction in the length of stay. We recommend subfascial infiltration with bupivicaine to the three laparoscopic sites and the pfannenstiel incision at the conclusion of the procedure to reduce postoperative pain. We believe this improvement in postoperative pain management will continue to make LDN even more appealing to the potential living kidney donor.

Stage

MEDLINE

Authors Full Name

Ashcraft, E E. Baillie, G M. Shafizadeh, S F. McEvoy, J R. Mohamed, H K. Lin, A. Baliga, P K. Rogers, J. Rajagopalan, P R. Chavin, K D.

Institution

Department of Surgery, Medical University of South Carolina, Charleston 29425, USA.

Date Created

20020327

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12. Laparoscopic partial upper pole nephrectomy in infants and children.

Horowitz M. Shah SM. Ferzli G. Syad PI. Glassberg KI.

BJU International. 87(6):514-6, 2001 Apr.

[Journal Article]

UI: 11298046

OBJECTIVE: To retrospectively review 5 years' experience of transperitoneal laparoscopic partial nephrectomy (LPN) in infants and children.

PATIENTS AND METHODS: Between January 1995 and December 1999, 14 upper-pole partial nephrectomies (seven right and seven left) were undertaken in 13 children (mean age 3.8 years, range 0.4-14). One patient underwent bilateral upper-pole LPN. No children required a lower-pole partial nephrectomy during the study period. Evaluation included renal ultrasonography, voiding cystourethrography, renal scintigraphy and contrast-enhanced computed tomography in some cases. Three ports (10, 5 and 5 mm) were used in all except two patients, who required an additional 2 mm port for liver retraction. The diseased parenchyma was transected with electrocautery or harmonic scalpel. The distal ureter was simply transected in the absence of reflux, but tied adjacent to the bladder if reflux was present.

RESULTS: The mean operative duration for LPN was 100 min, with an estimated blood loss of < 30 mL. A liquid diet was tolerated on the first morning after surgery and age-appropriate regular diet that evening in all except one patient. The mean hospital stay was 2.6 days. One patient had a significant decrease in haematocrit, which was managed conservatively, not requiring transfusion. Follow-up telephone interviews with the patients' parents showed that

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all were satisfied with the medical and cosmetic outcome.

CONCLUSION: Transperitoneal LPN is preferable to open partial nephrectomy because: (i) The magnification provided by laparoscopy provides excellent vision for the precise dissection of the parenchyma and distal ureter, avoiding injury to the healthy tissue; (ii) There is minimal blood loss, fast recovery and less surgical scarring, and when upper-pole partial nephrectomy is required, LPN is less damaging to the lower-pole. Unlike total nephrectomy, where debate remains about open vs laparoscopic methods, the specific advantages of LPN make it clearly preferable.

Stage

MEDLINE

Authors Full Name

Horowitz, M. Shah, S M. Ferzli, G. Syad, P I. Glassberg, K I.

Institution

The Division of Paediatric Urology, State University of New York, Downstate Medical Center, Brooklyn, NY, USA.

Date Created

20010412

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30. Resource use and postoperative outcome: basic elements in benchmarking

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