Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Apr 7.
doi: 10.1007/s11255-025-04468-4. Online ahead of print.

Enhanced recovery after surgery in laparoscopic kidney donor nephrectomy: the role of quadratus lumborum and transversus abdominis plane block

Cristian A Hernandez-Gaytán  1 , Jorge Alcacio-Mendoza  1 , Jose de Jesus Cendejas-Gomez  1 , Javier Gonzalez-Chavira  1 , Yoztinn Bernal-Benitez  1 , Humberto Zavaleta-Guraieb  1 , Cassandra Dominguez-Hernández  1 , Diana García-Campos  2 , Rafael P Leal-Villalpando  2 , Gerardo Tena-González Méndez  1 , Bernardo Gabilondo-Pliego  1 , Francisco Rodríguez-Covarrubias  3
Affiliations

Enhanced recovery after surgery in laparoscopic kidney donor nephrectomy: the role of quadratus lumborum and transversus abdominis plane block

Cristian A Hernandez-Gaytán et al. Int Urol Nephrol. .

Abstract

Purpose: Living donor kidney transplants (LDKTs) represent nearly 35% of all kidney transplants, with laparoscopic living donor nephrectomy (LLDN) being the standard surgical approach. Enhanced Recovery After Surgery (ERAS) protocols have demonstrated better perioperative outcomes in LLDN. This study evaluates the impact of an ERAS protocol on postoperative opioid consumption and length of stay (LOS) compared to standard of care (SC).

Methods: This experimental, prospective study included patients undergoing LLDN at a tertiary care center. The ERAS protocol included preoperative nutritional optimization, ultrasound-guided transversus abdominis plane (TAP) and quadratus lumborum (QL) block for multimodal analgesia, opioid restriction and early oral intake, and mobilization. The SC group followed traditional perioperative care.

Results: A total of 286 patients, 86 patients in ERAS group and 172 in SC group were analyzed. ERAS group significantly reduced LOS (1.59 ± 0.7 days vs 3.39 ± 1.85 days in the SC group, p < 0.001) and opioid consumption on postoperative day (POD) 1 and 2. The pain scores on POD 1 were lower in the ERAS group, with no differences by POD 2 or 3. There were no differences in operative time, complication rates, or renal function at 6 months between groups.

Conclusion: The ERAS protocol demonstrated significant advantages over SC, including shorter LOS and reduced opioid use, without compromising safety or long-term renal outcomes. These findings support the routine adoption of ERAS protocols in LLDN as a safe and feasible approach.

Keywords: Kidney transplant; Opioids; Quadratus lumborum block; Regional anesthesia; Transversus abdominis plane block.

PubMed Disclaimer

Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

References

    1. “United States Department of Health & Human Services, Organ Procurement & Transplantation Network. National data.,” Accessed September 9. [Online]. Available: https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/
    1. Muzaale AD et al (2014) Risk of end-stage renal disease following live kidney donation. JAMA 311(6):579–586. https://doi.org/10.1001/jama.2013.285141 - DOI - PubMed - PMC
    1. Rocca X, Espinoza O, Hidalgo F, Gonzalez F (2005) Laparoscopic nephrectomy: safe and comfortable surgical alternative for living donors and for good results of graft function. Transplant Proc 37(8):3349–3350. https://doi.org/10.1016/j.transproceed.2005.09.140 - DOI - PubMed
    1. Villeda-Sandoval CI et al (2013) Hand-assisted laparoscopic versus open donor nephrectomy: a retrospective comparison of perioperative and functional results in a tertiary care center in Mexico. Transplant Proc 45(9):3220–3224. https://doi.org/10.1016/j.transproceed.2013.03.055 - DOI - PubMed
    1. Bardram L, Funch-Jensen P, Jensen P, Crawford ME (1995) Recovery after laparoscopic colonic surgery with epidural analgesia, and early. The Lancet 345(8952):763–764

LinkOut - more resources