RT Journal Article
SR Electronic
T1 #35868 Individial anaesthetist variation in pain experience of donor nephrectomy patients
JF Regional Anesthesia & Pain Medicine
JO Reg Anesth Pain Med
FD BMJ Publishing Group Ltd
SP A315
OP A316
DO 10.1136/rapm-2023-ESRA.601
VO 48
IS Suppl 1
A1 Mackintosh, Karen
A1 Runciman, Nikole
A1 Joliffe, Samantha
A1 Thomson, Iain
YR 2023
UL http://rapm.bmj.com/content/48/Suppl_1/A315.abstract
AB Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)Background and Aims Enhanced recovery after surgery (ERAS) protocols have shown to improve patient outcomes in donor nephrectomies.The Donor Nephrectomy Improvement Programme at our hospital aided formation of ERAS guidelines in 2020. The first 3 phases of the project used to standardise anaesthetic technique have shown great improvements in the patient experience (figure 1, 2). We aim to see if the improvements from the previous 3 phases have been maintained, and what the results from individual anaesthetists are.Methods Ethical approval was not required as per the local audit committee. A retrospective search conducted from the Renal Transplant Database identified 109 donor nephrectomy patients from the introduction of the ERAS guidance over a 22-month period. Clinical notes were analysed reviewing: compliance with the guideline; length of stay; mobilisation day and intravenous morphine equivalents 48 hours postoperatively. Individual anaesthetists were only included if they had performed >5 cases. A case was deemed ‘compliant’, if all intraoperative/postoperative guidance was followed precisely.Results The percentage of cases the anaesthetist was fully compliant with the guidelines varied from 0-75% (figure 3). From figure 3, there is a correlation between high compliance and lower opioid use, a result repeated when analysing maximal pain scores.Abstract #35868 Figure 1 Donor nephrectomy analgesia guidelinesAbstract #35868 Figure 2 Opioid requirements in first 3 phasesAbstract #35868 Figure 3 Comparison of median opioid requirement by anaesthestistConclusions The ERAS programme and technique guidelines have hugely reduced variation in pain experience from phase 1 to 4. However, the variety between individual anaesthetists that remains can be explained, in part, by a lower degree of adhering fully to current guidance, with non-compliance associated with worse outcomes. Results have been fed back to the individual anesthetists.