The role of spinal anaesthesia in patients having a transperitoneal hand-assisted laparoscopic donor nephrectomy in an enhanced recovery setting has never been investigated.
We explored whether substituting a rectus sheath block (RSB) with spinal anaesthesia, as an adjunct to a general anaesthetic technique, influenced time-to-readiness for discharge in patients undergoing hand-assisted laparoscopic donor nephrectomy.
Prospective randomised open blinded end-point (PROBE) study with two parallel groups.
Tertiary University Hospital.
Ninety-seven patients undergoing a trans-peritoneal hand-assisted laparoscopic donor nephrectomy.
Patients (n=52) were randomly assigned to receive a general anaesthetic and a surgical RSB with 2 mg kg−1 of levobupivacaine at the time of surgical closure or a spinal anaesthetic with hyperbaric bupivacaine 12.5 mg and diamorphine 0.5 mg (n=45) before general anaesthesia.
The primary outcome was the time-to-readiness for discharge following surgery.
Median [IQR] times-to-readiness for discharge were 75 [56 to 83] and 79 [67 to 101] h for RSB and spinal anaesthesia and there was no significant difference in times-to-readiness for discharge (median difference 4 (95% CI, 0 to 20h; P
= 0.07)). There were no significant differences in pain scores at rest (P
= 0.91) or on movement (P = 0.66). Median 24-h oxycodone consumptions were similar (P
= 0.80). Nausea and vomiting scores were similar (P = 0.57) and urinary retention occurred in one vs. four patients with RSB and spinal anaesthesia, respectively (P
Substitution of RSB with spinal anaesthesia using 12.5 mg hyperbaric bupivacaine and 0.5 mg diamorphine, together with a general anaesthetic failed to confer any benefit on time-to-discharge readiness following transperitoneal hand-assisted laparoscopic donor nephrectomy. RSB provided similar analgesia in the immediate postoperative period with a low frequency of side-effects in this cohort.
ClinicalTrial.gov identifier: NCT02700217.