PD40-08 PERIPHERAL WOUND CATHETER VS EPIDURAL ANALGESIA IN OPEN RENAL SURGERY A PROSPECTIVE RANDOMIZED TRIAL

Abstract

You have accessJournal of UrologyCME1 Apr 2023PD40-08 PERIPHERAL WOUND CATHETER VS EPIDURAL ANALGESIA IN OPEN RENAL SURGERY A PROSPECTIVE RANDOMIZED TRIAL Linnéa Ekström Ehn, Helena Thulin, and Ove Gustafsson Linnéa Ekström EhnLinnéa Ekström Ehn More articles by this author , Helena ThulinHelena Thulin More articles by this author , and Ove GustafssonOve Gustafsson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003345.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Peri- and postoperative care includes pain relief and mobilization of the patient. Early recovery is of importance to improve postoperative patient outcome. Medication and medical disorders can affect possible choices of pain management regimes. Patients in Sweden undergoing open surgery have commonly recieved epidural analgesia (EA) for pain control, EA is considered the gold standard of postoperative pain relief. Side effects such as nausea, dizziness and impaired voiding of bladder or bowel can negatively affect mobilization and time to discharge from the surgical ward. Unusual but described side effects are permanent nerve palsy and death. Recently, less invasive methods for postoperative pain control have emerged. One method is a a peripheral wound catheter providing a continuous wound infusion (CWI) with local anestethics used together with oral analgesics. In other types of surgery with similar incision techniques such as liver surgery, the CWI has been proven safe. The CWI is not well described in urological open surgery. Our aim is to give an overview of the CWI method and to investigate if the CWI is a viable option to EA in open renal surgery. We will account for some of the findings in a prospective randomized trial conducted between 2017 and 2019 at Department of Urology in the Karolinska University Hospital. METHODS: At Karolinska University Hospital we made a prospective randomized trial comparing EA to CWI. 40 patients planned for open renal surgery with subcostal incision were randomized into either EA or CWI. Patients submitted self-evaluation forms on pain and quality of life (QoL) before and directly after surgery, at 1 and 6 months. Aim of the study was to assess mobilization, QoL, time to urinary catheter removal, time to first bowel movement and time to hospital discharge. Adverse events, wound complications or readmissions were noted. RESULTS: No significant differences in overall pain rates, complications or readmissions were detected. The CWI group had shorter time to urinary catheter removal, less nausea and shorter hospital stay than the EA group. No increased wound infections was seen with CWI. Self-reported patient satisfaction was equal. CONCLUSIONS: The CWI is a viable option to EDA as postoperative pain regime in patients undergoing open renal surgery. The CWI provides a good alternative to EA with less invasiveness and comparable outcomes. Preliminary data indicates that CWI can be used instead of EA in open renal surgery being both safe and cost-efficient. Source of Funding: No external fundings, Clinical trial © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1055 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Linnéa Ekström Ehn More articles by this author Helena Thulin More articles by this author Ove Gustafsson More articles by this author Expand All Advertisement PDF downloadLoading ...