Enhanced recovery after surgery in laparoscopic kidney donor nephrectomy: the role of quadratus lumborum and transversus abdominis plane block.

Abstract

Purpose: Living donor kidney transplants (LDKTs) represent nearly 35% of all kidney transplants, with laparoscopic living donor nephrectomy (LLDN) being the standard surgical approach. Enhanced Recovery After Surgery (ERAS) protocols have demonstrated better perioperative outcomes in LLDN. This study evaluates the impact of an ERAS protocol on postoperative opioid consumption and length of stay (LOS) compared to standard of care (SC).

Methods: This experimental, prospective study included patients undergoing LLDN at a tertiary care center. The ERAS protocol included preoperative nutritional optimization, ultrasound-guided transversus abdominis plane (TAP) and quadratus lumborum (QL) block for multimodal analgesia, opioid restriction and early oral intake, and mobilization. The SC group followed traditional perioperative care.

Results: A total of 286 patients, 86 patients in ERAS group and 172 in SC group were analyzed. ERAS group significantly reduced LOS (1.59 ± 0.7 days vs 3.39 ± 1.85 days in the SC group, p < 0.001) and opioid consumption on postoperative day (POD) 1 and 2. The pain scores on POD 1 were lower in the ERAS group, with no differences by POD 2 or 3. There were no differences in operative time, complication rates, or renal function at 6 months between groups.

Conclusion: The ERAS protocol demonstrated significant advantages over SC, including shorter LOS and reduced opioid use, without compromising safety or long-term renal outcomes. These findings support the routine adoption of ERAS protocols in LLDN as a safe and feasible approach.