Effect of rectus sheath block vs. spinal anaesthesia on time-to-readiness for hospital discharge after trans-peritoneal hand-assisted laparoscopic live donor nephrectomy A randomised trial

BACKGROUND The role of spinal anaesthesia in patients having a transperitoneal hand-assisted laparoscopic donor nephrectomy in an enhanced recovery setting has never been investigated. OBJECTIVE We explored whether substituting a rectus sheath block (RSB) with spinal anaesthesia, as an adjunct to a general anaesthetic technique, influenced time-to-readiness for discharge in patients undergoing hand-assisted laparoscopic donor nephrectomy. DESIGN Prospective randomised open blinded end-point (PROBE) study with two parallel groups. SETTING Tertiary University Hospital. PATIENTS Ninety-seven patients undergoing a trans-peritoneal hand-assisted laparoscopic donor nephrectomy. INTERVENTION Patients (n=52) were randomly assigned to receive a general anaesthetic and a surgical RSB with 2 mg kg(-1) of levobupivacaine at the time of surgical closure or a spinal anaesthetic with hyperbaric bupivacaine 12.5 mg and diamorphine 0.5 mg (n=45) before general anaesthesia. PRIMARY OUTCOME The primary outcome was the time-to-readiness for discharge following surgery. RESULTS Median [IQR] times-to-readiness for discharge were 75 [56 to 83] and 79 [67 to 101] h for RSB and spinal anaesthesia and there was no significant difference in times-to-readiness for discharge (median difference 4 (95% CI, 0 to 20h; P = 0.07)). There were no significant differences in pain scores at rest (P = 0.91) or on movement (P = 0.66). Median 24-h oxycodone consumptions were similar (P = 0.80). Nausea and vomiting scores were similar (P = 0.57) and urinary retention occurred in one vs. four patients with RSB and spinal anaesthesia, respectively (P = 0.077). CONCLUSION Substitution of RSB with spinal anaesthesia using 12.5 mg hyperbaric bupivacaine and 0.5 mg diamorphine, together with a general anaesthetic failed to confer any benefit on time-to-discharge readiness following transperitoneal hand-assisted laparoscopic donor nephrectomy. RSB provided similar analgesia in the immediate postoperative period with a low frequency of side-effects in this cohort.