Article ; Online: Effect of rectus sheath block vs. spinal anaesthesia on time-to-readiness for hospital discharge after trans-peritoneal hand-assisted laparoscopic live donor nephrectomy: A randomised trial.
European journal of anaesthesiology
2020 Volume 38, Issue 4, Page(s) 374–382
Abstract: Background: The role of spinal anaesthesia in patients having a transperitoneal hand-assisted laparoscopic donor nephrectomy in an enhanced recovery setting has never been investigated.: Objective: We explored whether substituting a rectus sheath ... ...
Abstract | Background: The role of spinal anaesthesia in patients having a transperitoneal hand-assisted laparoscopic donor nephrectomy in an enhanced recovery setting has never been investigated. Objective: We explored whether substituting a rectus sheath block (RSB) with spinal anaesthesia, as an adjunct to a general anaesthetic technique, influenced time-to-readiness for discharge in patients undergoing hand-assisted laparoscopic donor nephrectomy. Design: Prospective randomised open blinded end-point (PROBE) study with two parallel groups. Setting: Tertiary University Hospital. Patients: Ninety-seven patients undergoing a trans-peritoneal hand-assisted laparoscopic donor nephrectomy. Intervention: Patients (n=52) were randomly assigned to receive a general anaesthetic and a surgical RSB with 2 mg kg-1 of levobupivacaine at the time of surgical closure or a spinal anaesthetic with hyperbaric bupivacaine 12.5 mg and diamorphine 0.5 mg (n=45) before general anaesthesia. Primary outcome: The primary outcome was the time-to-readiness for discharge following surgery. Results: Median [IQR] times-to-readiness for discharge were 75 [56 to 83] and 79 [67 to 101] h for RSB and spinal anaesthesia and there was no significant difference in times-to-readiness for discharge (median difference 4 (95% CI, 0 to 20h; P = 0.07)). There were no significant differences in pain scores at rest (P = 0.91) or on movement (P = 0.66). Median 24-h oxycodone consumptions were similar (P = 0.80). Nausea and vomiting scores were similar (P = 0.57) and urinary retention occurred in one vs. four patients with RSB and spinal anaesthesia, respectively (P = 0.077). Conclusion: Substitution of RSB with spinal anaesthesia using 12.5 mg hyperbaric bupivacaine and 0.5 mg diamorphine, together with a general anaesthetic failed to confer any benefit on time-to-discharge readiness following transperitoneal hand-assisted laparoscopic donor nephrectomy. RSB provided similar analgesia in the immediate postoperative period with a low frequency of side-effects in this cohort. Trial registration: ClinicalTrial.gov identifier: NCT02700217. |
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MeSH term(s) | Anesthesia, Spinal ; Anesthetics, Local ; Bupivacaine ; Hand-Assisted Laparoscopy ; Hospitals ; Humans ; Living Donors ; Nephrectomy/adverse effects ; Nerve Block ; Pain, Postoperative/diagnosis ; Pain, Postoperative/etiology ; Pain, Postoperative/prevention & control ; Patient Discharge ; Prospective Studies |
Chemical Substances | Anesthetics, Local ; Bupivacaine (Y8335394RO) |
Language | English |
Publishing date | 2020-10-02 |
Publishing country | England |
Document type | Journal Article ; Randomized Controlled Trial |
ZDB-ID | 605770-6 |
ISSN | 1365-2346 ; 0265-0215 |
ISSN (online) | 1365-2346 |
ISSN | 0265-0215 |
DOI | 10.1097/EJA.0000000000001337 |
Database | MEDical Literature Analysis and Retrieval System OnLINE |
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