Abstract
The amount of reduction in opioid doses and its effect on postoperative pain outcomes in chronic kidney disease (CKD) patients in the perioperative setting remains unclear. This study aimed to investigate differences in postoperative pain outcomes after major laparoscopic surgery between patients with CKD and those with normal preoperative kidney function. Medical records of patients who underwent laparoscopic major abdominal surgery from January 2010 to December 2016 were retrospectively reviewed, and 6,612 patients were finally included. During postoperative day (POD) 0–3, patients with an estimated glomerular filtration rate (eGFR) < 30 mL min−1 1.73 m−2 had 3.5% lower morphine equivalent consumption than those with an eGFR ≥ 90 mL min−1 1.73 m−2 (P = 0.023), whereas patients with preoperative eGFR between 60–90 mL min−1 1.73 m−2 and 30–60 mL min−1 1.73 m−2 showed no significant differences in morphine equivalent consumption. Additionally, pain scores at rest during POD 0–3 were not significantly associated with preoperative kidney function. In conclusion, our results suggest that patients with mild to moderate CKD (stage 2–3) did not require reduction of opioid analgesics during POD 0–3, compared to patients with normal preoperative kidney function. Only patients with severe CKD (stage ≥ 4) might require a slight reduction of opioid analgesics.
Highlights
It is reported that about 80% of all surgical patients experience postoperative pain[1], and effective pain control plays an important role in lowering postoperative morbidity and mortality[2]
856 patients were excluded for age younger than 20 years, 1,053 were excluded for emergency surgery, 1,390 were excluded for single-port laparoscopy, 9,571 were excluded for surgery lasting less than 2 hours, 343 were excluded for receiving a continuous infusion of remifentanil or dexmedetomidine during the first three postoperative day (POD), 8 were excluded for being discharged before the third POD, 25 were excluded for undergoing additional surgery during the first three PODs, 42 were excluded for intraoperative conversion to open laparotomy, 96 were excluded for undergoing simple appendectomy or cholecystectomy, 58 were excluded due to preoperative chronic opioid usage, and 746 were excluded for missing or incomplete medical records
This study showed that opioid consumption was significantly lower in patients with stage 4 or 5 chronic kidney disease (CKD) than in those with normal kidney function during the first three days after major laparoscopic surgery, while it was not significantly associated with mild to moderate CKD
Summary
It is reported that about 80% of all surgical patients experience postoperative pain[1], and effective pain control plays an important role in lowering postoperative morbidity and mortality[2]. A recent study reported that opioids are commonly used until postoperative days (PODs) 4 to 15 among patients after common surgical procedures[4]. Patients with chronic kidney disease (CKD) are at risk of developing serious adverse effects of opioids. There is a lack of information regarding the impact of impaired renal function in patients with CKD on requirement for opioids and on pain outcomes in the perioperative setting. This study aimed to investigate differences in postoperative pain outcomes, including opioid consumption and pain scores, after major laparoscopic surgery, between patients with CKD and those with normal kidney function. Our hypothesis for this study was that a correlation exists between the degree of renal impairment and opioid consumption in patients with CKD stages 1–5, after major laparoscopic surgery www.nature.com/scientificreports/
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