Association Of Bowel Rest And Ketorolac Analgesia With Short Hospital Stay After Laparoscopic Donor Nephrectomy

August 8, 2007 – 12:05 am | posted in Urology / Nephrology

UroToday.com- The major factor keeping patients in the hospital for an average of two days after a laparoscopic renal procedure appears to be ileus. We, like many others, do not discharge our patients until they are ambulating, have active bowel sounds and flatus. Using the following regimen the authors noted that hospital stay among their donor nephrectomy patients could be reduced to 1.1 days. The regimen is:

a.) clear liquid diet for 2 days prior to surgery

b.) two bottles of 150 ml each of magnesium citrate orally on the day prior to surgery

c.) Fleets enema the evening prior to surgery

d.) NPO after midnight

Pain was managed with ketorolac 30 mg IV every 6 hours for up to 48 hours with parenteral narcotics as needed. Patients were not discharged until they were passing flatus. Also, the authors note that use of ketorolac for less than 5 days does not affect renal function. Likewise, they note no increase in bleeding with the use of ketorolac.

This sounds like a very sound system; will it work equally well in the older laparoscopic renal surgery population who are having partial nephrectomies or radical nephrectomies for cancer?

Breda A., Bui MH, Liao JC, Schulam PG

Urology. 69(5): 828-83, May 2007
doi:10.1016/j.urology.2007.01.083

Reported by UroToday.com Medical Editor Ralph V. Clayman, MD

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