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An Enhanced Recovery After Surgery protocol for robotic-assisted laparoscopic nephrectomies utilizing a quadratus lumborum block

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Abstract

Enhanced Recovery After Surgery (ERAS) protocols have been developed in several fields to reduce hospitalization lengths and overall costs. There have also been developments in multimodal analgesia methods to curtail opioid usage after surgery. Herein, we present the results of our initiation of an ERAS protocol for robotic-assisted laparoscopic partial and radical nephrectomies, employing a quadratus lumborum (QL) regional anesthetic block. We retrospectively reviewed 614 patients in our Institutional Review Board approved database who underwent robotic-assisted laparoscopic partial or radical nephrectomies from January 2017 to February 2020. An ERAS protocol utilizing multimodal analgesia (acetaminophen and gabapentin) and a QL block was developed and introduced in February 2019. We then compared the opioid consumption and perioperative outcomes of patients before and after ERAS protocol initiation. 192 ERAS patients (February 2019 to February 2020) were compared to 422 non-ERAS patients (January 2017 to January 2019). Baseline characteristics and the proportion of preoperative opioids users were similar between the two groups. There were no statistically significant differences in surgery length, hospitalization length, or complication rates. There were statistically significant differences in our primary endpoint, opioid consumption, on post-operative days 0 (p < 0.001), 1 (p < 0.001), and 2 (p < 0.001). The total opioid requirements over the course of admission were lower in the ERAS group compared to the non-ERAS group (p = 0.03). The initiation of an ERAS protocol employing multimodal analgesia and a QL block, for patients undergoing robotic-assisted laparoscopic partial or radical nephrectomies, can decrease opioid requirements without compromising perioperative outcomes.

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Abbreviations

ERAS:

Enhanced Recovery After Surgery

QL:

Quadratus Lumborum

LOS:

Length of stay

MME:

Morphine Milligram Equivalents

PACU:

Post Anesthesia Care Unit

POD:

Postoperative day

RALPN:

Robotic-Assisted Laparoscopic Partial Nephrectomy

RALRN:

Robotic-Assisted Laparoscopic Radical Nephrectomy

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Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. USC Institute of Urology, Keck School of Medicine, University of Southern California, 1441 Eastlake Ave, Los Angeles, CA, 90089, USA

    Wesley Yip, Andrew B. Chen, Akbar N. Ashrafi, John N. Graham, Mihir M. Desai, Inderbir S. Gill & Monish Aron

  2. Department of Anesthesiology, Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA, 90033, USA

    Cristin Malekyan, William Widjaja, Kevin Yan, Makela Stankey, Xue Sun, Shane C. Dickerson, Mohamed H. Eloustaz & Michael P. Kim

Authors
  1. Wesley Yip
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  2. Andrew B. Chen
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  3. Cristin Malekyan
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  4. William Widjaja
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  5. Kevin Yan
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  6. Makela Stankey
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  7. Xue Sun
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  8. Akbar N. Ashrafi
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  9. John N. Graham
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  12. Mihir M. Desai
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  13. Inderbir S. Gill
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  14. Monish Aron
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  15. Michael P. Kim
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by WY, ABC, CM, WW, KY, MS, and XS. The first draft of the manuscript was written by WY, ABC, SCD, MHE, and MPK, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Wesley Yip.

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The authors declare that there is no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Yip, W., Chen, A.B., Malekyan, C. et al. An Enhanced Recovery After Surgery protocol for robotic-assisted laparoscopic nephrectomies utilizing a quadratus lumborum block. J Robotic Surg 16, 1383–1389 (2022). https://doi.org/10.1007/s11701-022-01379-9

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  • DOI: https://doi.org/10.1007/s11701-022-01379-9

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