Prediction of Postsurgical Pain from Hand-Assisted Laparoscopic Nephroureterectomy

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Objective We retrospectively reviewed the medical records of patients who underwent hand-assisted laparoscopic nephroureterectomy using a retroperitoneal or transperitoneal approach at National Taiwan University Hospital. Early postsurgical pain scores and the amount of morphine equivalents consumed were evaluated. Patients and Methods From July 2001 to June 2005, a total of 96 patients who underwent hand-assisted laparoscopic nephroureterectomy and bladder cuff resection were retrospectively evaluated. Perioperative parameters, postoperative opioid dose, and daily pain score based on a 10-point visual analog scale (VAS) were recorded prior to discharge. Potential predictive factors included patient age, gender, body mass index, comorbid conditions, surgical time, patient controlled analgesia (PCA) use and surgical access. These were analyzed with regard to pain based on a daily VAS score and morphine dose (equivalents). Results The daily VAS score decreased from 4.7 ± 1.5 on the day of surgery to 2.0 ± 0.7 on postoperative day (POD) 6. Only the operation time was associated with a high VAS score on POD1 ( p < 0.01). On univariate analysis, a longer operation time ( p = 0.04) and PCA use ( p < 0.01) were associated with higher intake of morphine equivalents. Patients with end-stage renal disease (ESRD) required less morphine postoperatively ( p = 0.02). On multivariate analysis, PCA use ( p = 0.04), ESRD ( p = 0.045), and operation time ( p = 0.049) were independently associated with postoperative morphine dosage. Women had a trend of increased postoperative morphine use ( p = 0.06) The postoperative daily VAS score and opioid dosage were comparable in patients receiving trans-and retroperitoneal access. Conclusion Patients who had a longer operation had a significantly higher POD1 pain score. PCA use and prolonged operation time were predictive factors for a higher dosage of morphine.