Preoperatively, patients will be counseled on optimization of physical and nutritional status. They will receive carbohydrate loading drinks prior to surgery. Intraoperatively, standard ASA monitors will be utilized, and patients will receive general anesthesia. Goal directed fluid management will be enforced with bolus options based on hemodynamics. Transabdominal plane and rectus sheath block will be performed in the operating room by the regional anesthesia team. Post-operatively pain management will include multimodal analgesic medications. Regular diet will be allowed and encouraged on post-operative day 0 (POD). Lines and drains will be minimized to encourage early mobilization and bowel function. Patients will be counseled on expectations of discharge criteria POD0.

Patients will receive traditional care for donor nephrectomy. Patients will be instructed to fast for 24 hours preoperative. On day of surgery, standard monitors will be used, and intraoperative management per anesthesiologists discretion including pain management. Post-operative, patients will receive pain medications, including opioids, as needed. Intravenous fluids will be continued until patients tolerate liquids per os. Bowel regimen will be ordered as needed. Patients will be discharged once meeting pre-set criteria.

Opioid Use

Kidney Diseases

Pain, Postoperative

Postoperative Complications

Postoperative Nausea and Vomiting

Regional anesthesia techniques, specifically rectus sheath and transabdominal plane blocks, for pain management will be performed.

multimodal pain management

Intraoperatively fluids will be administered based on hemodynamic parameters, in addition to clinical judgement.

goal directed fluid management

Patient's nutrition will be optimized preoperatively by administering carbohydrate drinks, and limiting fasting time.

preoperative carbohydrate loading

All patient will have laparoscopic nephrectomy procedure with transplant surgery.

Donor nephrectomy

transabdominal plane and rectus sheath nerve block

regional anesthesia

Thomas Jefferson University Hospital

Enhanced Recovery After Surgery in Kidney Transplant Donors

Enhanced Recovery After Surgery in Living Donor Kidney Transplant Donors

amount of opioid pain medication required post operatively

Hospital length of stay from day of surgery to discharge.

Post operative time to first sign of bowel function, either flatus or bowel movement.

Post operative time following surgery until patient takes liquid/solid per os.

Patient experience survey will be administered on last day of hospitalization. 14 question survery adapted from Cabellos M, et. al. Member of research team will distribute survey for completion by patients on last day of surgery. Survey focuses on pain management, communiation, recovery progression, facilities, and overall experience. Selection of open answer and likert scale questions.

Thomas Jefferson University

First to use standard white light to observe, to record spasm score, to observe the lesion.Buscopan (BSP, 20mg) is administered by endoscopic nurse, recorded blindly.

First to use standard white light to observe, to record spasm score, to observe the lesion.Scopolamine is administered by endoscopic nurse, recorded blindly.

First to use standard white light to observe, to record spasm score, to observe the lesion. Physiological saline is administered by endoscopic nurse, recorded blindly.

Gastrointestinal Imaging With pCLE

Buscopan is administered by endoscopic nurse in the Buscopan group,and then recording the outcome measures.

Buscopan

Scopolamine is administered by endoscopic nurse in the Scopolamine group,and then recording the outcome measures.

Scopolamine

Physiological saline is administered by endoscopic nurse in the physiological saline group,and then recording the outcome measures.

physiological saline

Xijing Hospital of Digestive Diseases

Effect of Buscopan on Gastrointestinal Imaging Quality With Probe-based Confocal Laser Endomicroscopy

the rate which spasm score decline was significant (spasm score decline two points before and after the drug)

the rate of participants among which the pCLE diagnosis agree with the pathologic diagnosis

hypersensitivity/skopolamin

Enhanced Recovery After Surgery in Kidney Transplant Donors

Effect of Buscopan on Gastrointestinal Imaging Quality With Probe-based Confocal Laser Endomicroscopy

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