Korean J Transplant.  2023 Nov;37(Suppl 1):S137. 10.4285/ATW2023.F-7199.

The efficacy and safety of continuous epidural analgesia in kidney transplant recipients: a propensity score matching analysis

• Lapisatepun W
• Changthima P
• Wongkiti P
• Lapisatepun W

• KMID: 2551757
• DOI: http://doi.org/10.4285/ATW2023.F-7199

Abstract

Background
The modality of postoperative analgesia after kidney transplantation is limited due to specific conditions of recipients patient. Epidural analgesia (EA) is an analgesic mainstay for abdominal surgery but controversial for kidney transplantation due to risk of bleeding from platelet dysfunction. The aim of this study is to compare the postoperative analgesic effect as well as safety between continuous EA and intravenous opioid analgesia in kidney transplant recipients.
Methods
In this single center, retrospective study, 361 end-stage renal failure adults, who underwent kidney transplantation from 2005 to 2020, were reviewed. Continuous EA was administered to 218 patients, while intravenous opioids (IO) were given to 143 patients. Confounders were adjusted by propensity-score matching with a 1:1 matching ratio. Cumulative fentanyl consumption at 72 hours postoperatively were recorded as primary outcome. Secondary outcomes were complications-associated IO and EA, length of hospital and intensive care unit (ICU) stay.
Results
After propensity score matching, the final sample included 94 patients per group with balanced preoperative covariates. Patients in the EA group had significant lower postoperative fentanyl consumption in 72 hours compared to the IO group (50 [0–100] vs. 100 [50–200] mcg; P<0.001). Nevertheless, the incidences of postoperative nausea, vomiting, bradycardia, and respiratory depression were similar in two groups. There was no difference in length of hospital and ICU stay. Furthermore, no patient receiving epidural block had developed an epidural hematoma.
Conclusions
The continuous EA is effective and safe technique. It significantly reduced postoperative opioid consumption comparing to intravenous opioid analgesia after kidney transplantation.