EFFECTS OF PREOPERATIVE INTRATHECAL MORPHINE ON POSTOPERATIVE PAD IN LIVING DONOR KIDNEY TRANSPLANTATION RECIPIENTS

Abstract

Purpose: Postoperative PAD (pain, agitation, and delirium), especially delirium in living donor kidney transplantation (LDKT) recipients is a risk factor for increased morbidity, length of hospital stay, graft failure, and mortality. In its guideline for management of PAD, the American College of Critical Care Medicine emphasizes the importance of postoperative analgesia, and previous studies have shown effective pain control decreases the incidence and severity of postoperative delirium. Intrathecal morphine is a commonly used method of analgesia, but the effect of preoperative intrathecal morphine on postoperative PAD has not been studied in LDKT recipients. The purpose of this study is to evaluate the effects of preoperative intrathecal morphine on postoperative PAD in LDKT recipients. Methods: LDKT recipients in our institution received intrathecal morphine for the purpose of postoperative pain control if not contraindicated. With IRB approval we compared the incidence of PAD between recipients without intrathecal morphine (control group) and with intrathecal morphine (ITM group) who underwent LDKT (Jan. 2014 – Dec. 2018). Primary outcome was the incidence of delirium as detected by CAM-ICU score. Secondary outcomes were pain expressed as NRS, opioid consumption in milligrams equivalent morphine dose, agitation level expressed as RASS, antipsychotic/sedative consumption, length of hospital/ICU stay, and frequency of prolonged (>3days) ICU stays. Results: 339 recipients were included in the analysis with 166 in control group and 173 in ITM group. The incidence of delirium were 4.82% and 1.16% in control group and ITM group, respectively (p=0.046). There were significant differences in the pain and opioid consumption at POD0 and 1 between two groups. However, there were no significant differences in terms of agitation level and antipsychotics/sedative consumption. Also, the length of hospital/ICU stay and frequency of prolonged ICU stay were comparable between two groups. Conclusion: Preoperative intrathecal morphine in LDKT recipients reduced postoperative pain and delirium. Further study is warranted to investigate other risk factors on PAD in the ICU experience of transplantation recipients.