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Title
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Comparison of early postoperative pain after partial tumour nephrectomy by flank, transabdominal or laparoscopic access
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Author
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Abstract
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| Aim: To explore whether the total pain experience differs after (partial) kidney tumour nephrectomies via flank, transabdominal or laparoscopic access. Materials and methods: We analyzed retrospectively 107 patients with flank, 12 with transabdominal and 21 with laparoscopic interventions. For pain treatment, conventional analgesics (A) or intravenous patient-controlled analgesia (PCIA) or thoracic peridural analgesia (tPDA) were used. Self-reported pain was measured with a Visual Analogue Scale three times daily. The area under the curve (AUC) at rest (R) and during a standardized body movement (M) were calculated from the intervention tilt the end of the second T(0-2) and seventh postoperative day T(0-7), respectively. Results: The median AUC for T(0-2) at R was more intense for laparoscopy (13) than for flank incision (A, 9) and approximately the same during M. For flank incisions (A), the median AUC at R rises from 9 for T(0-2) to 22 for T(0-7) and at M the median AUC increases from 18 to 37. In contrast, laparoscopy did not cause further pain after the second postoperative day. Furthermore, with flank incision for T(0-2), at R, tPDA was superior to A (median AUC: 5 versus 9, p = 0.02) and at M again tPDA (median AUC: 12) had a better pain-control as A (18) or even as PCIA (19, p = 0.005). Conclusion: Laparoscopic nephrectomies cause a relatively intense mean cumulative pain for T(0-2) and a subsequent absence of pain. However, flank incisions went on to increased pain levels until the seventh postoperative day with tPDA as most effective therapy. |
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Language
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English
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Source (journal)
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British Journal of Pain
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Publication
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2019
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ISSN
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2049-4637
2049-4645
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DOI
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10.1177/2049463718808542
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Volume/pages
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13
:3
(2019)
, p. 177-184
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ISI
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000474422800005
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Full text (Publisher's DOI)
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