2021, Number 1
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Rev Mex Anest 2021; 44 (1)
Cost description of protocolized analgesic treatment with epidural catheter versus conventional analgesia for open kidney donor nephrectomy in the Mexican Institute of Social Security
Rascón-Martínez DM, Flores-Rodríguez MY, Hernández-Hernández FL, Martínez-Castillo G, A CG, Arrocena-Salgado R, Castellanos-Olivares A
Language: Spanish
References: 36
Page: 13-21
PDF size: 314.38 Kb.
ABSTRACT
Introduction: Pain in renal donors after open nephrectomy, transcends in full recovery of activities in daily life and exposes an economic impact in health institutions.
Objective: To describe the costs of protocolized analgesia during the immediate postoperative period of renal donor patient.
Material and methods: We conducted a longitudinal, randomized, non-blinded clinical trial which compared two different analgesic treatments: one protocolized versus conventional analgesia through a cost analysis model from the Institutional Social Security perspective.
Results: In average, protocolized analgesia obtained a higher cost with 53.25 US$ (52.34-53.79) opposed to the conventional analgesia treatment with 18.84 US$ (4.55-19.34); U = -6.0, p < 0.001. However, 89.2% of the patients in protocolized analgesia qualified this intervention as excellent compared to the conventional treatment with only 41.2%, χ
2 = 18.78; p < 0.001. Similarly, patients in protocolized analgesia were more satisfied with a reported median (Me) = 10; (25th percentile = 10-75th percentile = 10) compared to those who received conventional treatment, Me = 8; (25th percentile = 8-75th percentile = 9) (U = -5.9, p < 0.001). Conclusions. The use of Protocolized Analgesia with epidural catheter showed a clinical and statistically significant difference concerning to pain, efficacy and a greater satisfaction report in patients undergoing open nephrectomy for renal donation, although does not decrease the costs of analgesic care during immediate postoperative period.
REFERENCES
Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY, et al. Comparison of mortality in all patient on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med. 1999;341:1725-1730.
United Network for Organ Sharing. Available in: http://www.unos.org/.
The Organ Procurement and Transplantation Network. Available in: http://www.optn.org.
Oosterlee A, Rahmel A, van Zwet W (eds). Annual report 2005. Eurotransplant International Foundation, Leiden: 2005.
Malaise J, Van Deynse D, Dumont V, Lecomte C, Mourad M, Dufrane D, et al. Non-heart-beating donor, 10-year experience in a Belgian transplant center. Transplant Proc. 2007;39:2578-2579.
Sells RA, Johnson R, Hutchinson I. Recommendations on the use of living kidney donors in the United Kingdom. British Transplantation Society. Br Med J (Clin Res Ed). 1986;293:257-258.
Dalla Valle R, Mazzoni MP, Capocasale E, Busi N, Pietrabissa A, Moretto C, Gualtierotti M, Massa M, Mosca F, Sianesi M. Laparoscopic donor nephrectomy: short learning curve. Transplant Proc. 2006;38:1001-1002.
Berardinelli L. Technical problems in living donor transplantation. Transplant Proc. 2005;37:2449-2450.
Matas AJ, Bartlett ST, Leichtman AB, Delmonico FL. Morbidity and mortality after living kidney donation, 1999-2001: survey of united states transplant centers. Am J Transplant. 2003;3:830-834.
Hadjianastassious VG, Johnson RJ, Rudge CJ, Mamode N. 2509 living donor nephrectomies, morbidity and mortality, including the UK introduction of laparoscopic donor surgery. Am J Transplant. 2007;7:2532-2537.
Gottschalk A, Götz J, Zenz M, Schmerz. Pain and quality of life for living donors after nephrectomy. Schmerz (Berlin, Germany) [Schmerz], ISSN: 1432-2129, 2009;23:502-509; Publisher: Springer-Verlag; PMID: 1976363.
Coley KC, Williams BA, DaPos SV, Chen C, Smith RB. Retrospective evaluation of unanticipated admissions and readmissions after day surgery and associated cost. J Clin Anesth. 2002;14:349-353.
Steyaert A, De Kock M. Chronic postsurgical pain. Curr Opin Anaesthesiol. 2012;25:584-588.
Johansen A, Romundstad L, Nielsen CS, Schirmer H, Stubhaug A. Persistent postsurgical pain in a general population: prevalence and predictors in the Tromso study. Pain. 2012;153:1390-1396.
Kehlet H, Wilkinson RC, Fischer HB, Camu F. PROSPECT: evidence-based, procedure-specific postoperative pain management. Best Pract Res Clin Anaesthesiol. 2007;21:149-159.
http://www.anzca.edu.au/resources/college-publications.
Warfield CA, Kahn CH. Acute pain management. Programs in U.S. hospitals and experiences and attitudes among U.S. adults. Anesthesiology. 1995;83:1090-1094.
Forastiere E, Sofra M, Giannarelli D, Fabrizi L, Simone G. Effectiveness of continuous wound infusion of 0.5% ropivacaine by On-Q pain relief system for postoperative pain management after open nephrectomy. Br J Anaesth. 2008;101:841-847.
Kehlet H, Dahl J. Anaesthesia, surgery, and challenges in postoperative recovery. Lancet. 2003;362:1291.
Panaro F, Gheza F, Piardi T, Woehl Jaegle ML, Audet M, Cantù M, et al. Continuous infusion of local anesthesia after living donor nephrectomy: a comparative analysis. Transplant Proc. 2011;43:985-987.
Werawatganon T, Charuluxanun S. Patient controlled intravenous opioid analgesia versus continuous epidural analgesia for pain after intra-abdominal surgery. Cochrane Database Syst Rev. 2005;(1):CD004088.
Jones KW, Peters TG, Charlton RK, Lenz BJ, Walker GW, Repper S, et al. Current issues in living donor nephrectomy. Clin Transplant. 1997;11:505-510.
Peters TG, Repper SM, Jones KW, Walker GW, Vincent M, Hunter RD. Living kidney donation: recovery and return to activities of daily living. Clin Transplant. 2000;14:433-438.
Guidelines for living donor kidney transplantation. Fourth Edition January 2018. British Transplantation Society. Disponible online en: www.bts.org.uk.
Patil SS, Kudalkar AG, Tendolkar BA. Comparison of continuous epidural infusion of 0.125% ropivacaine with 1 μg/mL fentanyl versus 0.125% bupivacaine with 1 μg/mL fentanyl for postoperative analgesia in major abdominal surgery. J Anaesthesiol Clin Pharmacol. 2018;34:29-34.
Diario Oficial de la Federación. Instituto Mexicano del Seguro Social. Disponible en: https://dof.gob.mx/nota_detalle.php?codigo=5583111&fecha=30/12/2019&print=true.
Solis E, Evangelista LA. Epidemiological characteristics of the largest kidney transplant program in Mexico: Western National Medical Center, Mexican Institute of Social Security. Transplant Proc. 2016;48:1999-2005.
Güner Can M, Göz R, Berber ?, Kaspar Ç, Çak?r Ü. Ultrasound/laparoscopic camera-guided transversus abdominis plane block for renal transplant donors: a randomized controlled trial. Ann Transplant. 2015;20:418-423.
Hosgood S, Thiyagarajan U. Randomized clinical trial of transversus abdominis plane block versus placebo control in live-donor nephrectomy. Transplantation. 2012;94:520-525.
Oliveira B, Mascarenhas C. Assessment of the degree of satisfaction among living kidney donors. Transplantation Proceedings. 2011;43:43-47.
Klarenbach S, Gill S. Economic consequences incurred by living kidney donors: a Canadian multi-center prospective study. Am J Transplant. 2014;14:916-922.
Rodrigue J, Schold J. For the kdoc study group. Direct and indirect costs following living kidney donation: findings from the KDOC Study. Am J Transplant. 2016;16:869-887.
Bartha E, Carlsson P, Kalman S. Evaluation of costs and effects of epidural analgesia and patient-controlled intravenous analgesia after major abdominal surgery. Br J Anaesth. 2006;96:111-111.
De Graaf Olson W, Bogett-Dumlao A. Living donors' perception of their quality of health after donation. Prog Transplant. 2001;11:108-115.
Drummond MF, O'Brien B, Stoddart GL, Torrance GW. Methods for the economic evaluation of health care programs. 2nd ed., Oxford: Oxford University Press; 1997.
Zarate V. Evaluaciones económicas en salud: conceptos básicos y clasificación. Rev Med Chile. 2010;138:93-97.