How painful is donor nephrectomy?: Retrospective analysis of early pain and pain management in open versus laparoscopic versus retroperitoneoscopic nephrectomy

Background. The aim of this study was to evaluate the early postoperative pain and pain management after standard open (ODN), hand-assisted laparoscopic (HLDN) and retroperitoneoscopic (RDN) donor nephrectomy. Methods. The visual analogue scale (VAS) was determined twice a day in 203 donors during the first five days after nephrectomy. Results. Mean VAS was significantly lower after RDN and HLDN than after ODN on day 2 (p=0.004) and days 3-5 (p < 0.001). After RDN, "no pain" (VAS=0) was reported significantly earlier than after ODN. Irrespective of the technique used and the pain management, all donors reported significantly higher VAS in the morning. Opiates were administered for a significantly shorter average time period after RDN than after ODN (p = 0.005). Cumulative morphine equivalent doses were higher after ODN than after RDN (p=0.001). Mean VAS reported after HLDN and RDN was similar. Conclusions. In summary, RDN and HLDN were clearly associated with much less early pain than ODN, independently of the used pain management.