Morphine patient controlled analgesia for postoperative analgesia in patients who have transplanted cadaver donor kidneys

Introduction: Patients who have chronic renal disease present challenges to anesthesiologists because of the sequelae of the underlying disease. Postoperative pain is usually mild to moderate after renal transplantation and is a concern because of underlying co-morbidities and variable responses of the graft. Effective postoperative pain management contributes to a a successful outcome after renal transplantation. Methods: A retrospective study, based on the collected data from clinical process and registration of the acute pain unit. Results: During 2007 and 2008, 124 patients were transplanted with cadaver donor kidneys. The final sample included 55 patients, namely 67% males and 33% females, whose ages range between 15 and 75 years (average, 47.23 years). Their American Society of Anesthesiologists physical status classification was 4 in 71% and 3 in 29%. Analgesia during surgery used a fentanyl, paracetamol and morphine protocol (n = 47) or fentanyl, paracetamol, morphine, and local anesthetic infiltration (n = 8). The postoperative pain was quantified using a numerical rating scale (0-4) with mean value of 1.07 on day 1, a mean value of 1 on day 2, and a mean value of 0.67 on day 3. Postoperative analgesia with morphine patient-controlled analgesia was used for every patient, combined with paracetamol in 89% of cases. The average number of bolus demands was 60 with 26.4 effective boluses, the mean total administered dose was 26.6 mg. The major side effects were constipation (18%), pruritus (14%), nausea (13%), and vomiting (1.8%). The following relations were significance: age and score of pain, pruritus and total dose of morphine, preoperative analgesia, and pain score on day 2. Conclusions: Our results suggest that analgesia with morphine patient-controlled analgesia was an effective method to achieve control of postoperative pain in this population with few side effects.