Analgesia after major laparoscopic surgery in patients with chronic kidney disease: A retrospective cohort study

The amount of reduction in opioid doses and its effect on postoperative pain outcomes in chronic kidney disease (CKD) patients in the perioperative setting remains unclear. This study aimed to investigate differences in postoperative pain outcomes after major laparoscopic surgery between patients with CKD and those with normal preoperative kidney function. Medical records of patients who underwent laparoscopic major abdominal surgery from January 2010 to December 2016 were retrospectively reviewed, and 6,612 patients were finally included. During postoperative day (POD) 0-3, patients with an estimated glomerular filtration rate (eGFR) < 30 mL min^-1 1.73 m^-2 had 3.5% lower morphine equivalent consumption than those with an eGFR ≥ 90 mL min^-1 1.73 m^-2 (P = 0.023), whereas patients with preoperative eGFR between 60-90 mL min^-1 1.73 m^-2 and 30-60 mL min^-1 1.73 m^-2 showed no significant differences in morphine equivalent consumption. Additionally, pain scores at rest during POD 0-3 were not significantly associated with preoperative kidney function. In conclusion, our results suggest that patients with mild to moderate CKD (stage 2-3) did not require reduction of opioid analgesics during POD 0-3, compared to patients with normal preoperative kidney function. Only patients with severe CKD (stage ≥ 4) might require a slight reduction of opioid analgesics.