Preoperative Intrathecal Morphine is Associated With Reduced Postoperative Pain, Agitation, and Delirium In Living Donor Kidney Transplantation Recipients

Abstract

BackgroundPostoperative delirium after organ transplantation can lead to increased length of hospital stay and mortality. Since pain is an important risk factor for delirium, perioperative analgesia with intrathecal morphine (ITM) may mitigate postoperative delirium development. We evaluated if ITM reduces postoperative delirium incidence in living donor kidney transplant (LDKT) recipients. Methods296 patients who received LDKT between 2014 and 2018 at our hospital were retrospectively analyzed. Recipients who received preoperative ITM (ITM group) were compared to those who did not (control group). Primary outcome was postoperative delirium based on Confusion Assessment Method for Intensive Care Unit results during the first four postoperative days. ResultsDelirium occurred in 2.6% (4/154) and 7.0% (10/142) of ITM and control groups, respectively. Multivariable analysis showed age (OR: 1.07, 95% CI: 1.01-1.14; P = 0.031), recent smoking (OR: 7.87, 95% CI: 1.43-43.31; P = 0.018), preoperative psychotropics (OR: 23.01, 95% CI: 3.22-164.66; P = 0.002) were risk factors while ITM was a protective factor (OR: 0.23, 95% CI: 0.06-0.89; P = 0.033). ConclusionPreoperative ITM showed an independent association with reduced post-LDKT delirium. Further studies and development of regional analgesia for delirium prevention may enhance postoperative recovery of transplant recipients.