Comparison of early postoperative pain after partial tumour nephrectomy by flank, transabdominal or laparoscopic access

Abstract

Aim: To explore whether the total pain experience differs after (partial) kidney tumour nephrectomies via flank, transabdominal or laparoscopic access.

Materials and methods: We analyzed retrospectively 107 patients with flank, 12 with transabdominal and 21 with laparoscopic interventions. For pain treatment, conventional analgesics (A) or intravenous patient-controlled analgesia (PCIA) or thoracic peridural analgesia (tPDA) were used. Self-reported pain was measured with a Visual Analogue Scale three times daily. The area under the curve (AUC) at rest (R) and during a standardized body movement (M) were calculated from the intervention till the end of the second T(0-2) and seventh postoperative day T(0-7), respectively.

Results: The median AUC for T(0-2) at R was more intense for laparoscopy (13) than for flank incision (A, 9) and approximately the same during M. For flank incisions (A), the median AUC at R rises from 9 for T(0-2) to 22 for T(0-7) and at M the median AUC increases from 18 to 37. In contrast, laparoscopy did not cause further pain after the second postoperative day. Furthermore, with flank incision for T(0-2), at R, tPDA was superior to A (median AUC: 5 versus 9, p = 0.02) and at M again tPDA (median AUC: 12) had a better pain-control as A (18) or even as PCIA (19, p = 0.005).

Conclusion: Laparoscopic nephrectomies cause a relatively intense mean cumulative pain for T(0-2) and a subsequent absence of pain. However, flank incisions went on to increased pain levels until the seventh postoperative day with tPDA as most effective therapy.

Keywords: Area under the curve; flank incision; laparoscopic nephrectomy; partial tumour nephrectomy; postoperative pain.

Figure 1.

The area under the curve (AUC) from the day of the intervention till the end of the second postoperative day for all seven subgroups (a) at rest and (b) at standardized body movements. Note, maximal AUC is 90 VAS.

Figure 2.

The area under the curve (AUC) from the day of the intervention up to the end of the seventh postoperative day (T(0–7)) for all seven subgroups (a) at rest and (b) during a standardized body movement. Note that maximal AUC is 240 VAS. For patients operated by laparoscopic surgery, no AUC could be calculated for T(0–7), since most patients had already been discharged.

Figure 3.

The area under the curve (AUC) of self-reported pain of the laparoscopic patients (a) at rest and (b) during a standardized body movement in dependence of time.