Breda A et al. (2007) Association of bowel rest and ketorolac analgesia with short hospital stay after laparoscopic donor nephrectomy. Urology 69: 828–831

New research from the University of California, Los Angeles, reports that a combination protocol of ketorolac analgesia and strict bowel preparation reduced the time in hospital following laparoscopic live-donor nephrectomy.

All patients who underwent laparoscopic donor nephrectomy (n = 300) between 2000 and 2005 at the authors' institution were put on 2 days of clear liquid diet before surgery, and instructed to take two bottles of magnesium citrate 1 day before surgery, to self-administer a Fleets enema the evening before surgery, and to fast from midnight. After surgery, 30 mg of ketorolac—an NSAID for the control of postoperative pain—was administered intravenously every 6 hours for 48 hours, with additional narcotics given when needed.

All patients tolerated the preoperative regimen. The mean operative time was 180 ± 55 min, mean blood loss was 80 ± 50 ml, and warm ischemia time was 4 ± 2 min. The mean hospital stay was 1.1 days (range 1–3), with 96.7% of patients able to leave on postoperative day 1. There were no readmissions or emergency room visits. On the day after surgery, over 97% of patients could eat a normal lunch and walk with oral pain medication. Patients requiring longer hospital stays of 2–3 days required intravenous analgesia (n = 6) or had postoperative ileus (n = 4). No renal impairment was reported.

The authors attribute the reduced hospital stay to better analgesia and a faster return to normal bowel function, resulting from the bowel preparation regimen, but note that this was not a controlled randomized study.