• Kailash Bhatia, Malachy Columb, Richard Wadsworth, William Macnab, Chandran Jepegnanam, Tunde Campbell, and David Van Dellen.
• From the Department of Anaesthesia, Manchester Royal Infirmary (KB, RW, WM, CJ), Department of Anaesthesia and Intensive Care, Wythenshawe Hospital (MC) and Department of Transplant Surgery, Manchester Royal Infirmary, Manchester University Hospital NHS Foundation Trust, Manchester, UK (TC, DVD).
• Eur J Anaesthesiol. 2021 Apr 1; 38 (4): 374382374-382.

BackgroundThe role of spinal anaesthesia in patients having a transperitoneal hand-assisted laparoscopic donor nephrectomy in an enhanced recovery setting has never been investigated.ObjectiveWe 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.DesignProspective randomised open blinded end-point (PROBE) study with two parallel groups.SettingTertiary University Hospital.PatientsNinety-seven patients undergoing a trans-peritoneal hand-assisted laparoscopic donor nephrectomy.InterventionPatients (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 OutcomeThe primary outcome was the time-to-readiness for discharge following surgery.ResultsMedian [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).ConclusionSubstitution 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.Trial RegistrationClinicalTrial.gov identifier: NCT02700217.Copyright © 2020 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

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