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Master Thesis

Douleur chez le donneur de rein : comparaison de la consommation morphinique post-opératoire entre les néphrectomies donneur vivant et les néphrectomies pour cause médicale

Abstract : Introduction : Living donor kidney transplantation is the best treatment for end-stage kidney disease. Evaluation and treatment of the living donor’s pain are key elements for the development of this technique. Few studies evaluated the postoperative pain and its impact on recovery after kidney donation. The aim of this study was to compare the postoperative morphine consumption and pain scores between kidney living donors and patients undergoing therapeutic nephrectomy. Methods : After informed consent, 39 patients undergoing laparoscopic nephrectomy were included in a prospective observational monocentric study : 24 living donors (LD group) and 15 patients scheduled for radical nephrectomy (RN group). Anesthesia protocol and postoperative analgesia were the same in both groups. Peroperative analgesia was provided by target-controlled infusion of sufentanil, continuous i.v. lidocaine and ketamine infusion. Postoperative analgesia included paracetamol, nefopam and morphine patient-controlled analgesia (PCA). The primary endpoint was the cumulative amount of morphine at H72 after surgery. Secondary endpoints included demographic and peroperative data, morphine consumption and pain scales (VAS) at H0, H8, H16, H24, and H48 after surgery. Morphine-related side effects, length of stay and anxiety scores at H24 and 3 months after surgery were compared between both groups. Results : No significant difference was found in morphine consumption at H72 between both groups (14mg [6-22] for LD group, versus 13 mg [10-33] for RN group, p=0.511). Morphine consumption and pain scores were similar between the two groups at H0, H8, H16, H24, and H48. Living donors were more likely to be female (58% versus 27% in RN group, p=0.027). There was more hypertension in RN group (47% versus 8% in LD group, p = 0.012), and lower glomerular filtration rate (85ml/min/m2 versus 103 in LD group, p< 0.0001). Anesthesia was longer in LD group (270 min versus 220 min in RN group, p< 0.001). There was no difference between the two groups regarding anxiety scores at H24 (p=0.977) and at 3 months (p=0.883) after surgery. Morphine-related side effects and hospital length of stay were similar between both groups (p=0.299). Conclusion : Living kidney donors did not seem to suffer more pain than patients undergoing laparoscopic nephrectomy. Minimizing postoperative pain and reducing the impact of kidney donation on the donor’s quality of life are of particular importance in this context.
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https://dumas.ccsd.cnrs.fr/dumas-01343365
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Submitted on : Friday, July 8, 2016 - 12:07:27 PM
Last modification on : Wednesday, August 23, 2017 - 4:33:24 PM

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Pierre-André Stöckle. Douleur chez le donneur de rein : comparaison de la consommation morphinique post-opératoire entre les néphrectomies donneur vivant et les néphrectomies pour cause médicale. Médecine humaine et pathologie. 2016. ⟨dumas-01343365⟩

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