BACKGROUND: Appropriate pain control by a multimodal analgesic regimen has been shown to accelerate post-operative recovery in non-transplant surgery. However, the effectiveness of TAP block after kidney transplant surgery is unclear.

METHODS: In a single-center retrospective study, we reviewed adult kidney recipients from April to August 2017. Consented patients had either continuous (Group C, N=26) or single-shot (Group S, N=24) TAP blocks immediately after transplant surgery in the operating room or post-anesthesia care unit (PACU). The remaining patients (Group N, N=41) had no regional analgesia. Groups C and S patients received a bolus of long-acting local anesthetic (0.2-0.5% ropivacaine, 10-50 ml) under ultrasound guidance. Group C patients further received continuous infusion of ropivacaine (0.2%, 4-12 ml/hr) through the TAP catheter. All patients received parenteral/oral opioids for break-through pain in addition to acetaminophen for mild-to-moderate pain.

RSULTS: Demographic data were comparable among the groups. While the pain scale at PACU discharge was lower in Group C than Group N (2[1-4] and 4[3-7], respectively, P=0.0031), Group S had a numerically higher pain scale (6[3-7], P=0.5578 vs. Group N). Overall, parenteral opioid requirements of TAP patients were not significantly different from those of Group N patients in PACU (Groups C: 8.4[5.7-13.8], S: 9.9[3.9-14.4] and N: 7.5[2.1-15.6] mg, median[IQR] parenteral morphine equivalent dose) and post-PACU (Groups C: 3.6[1.2-11.7], S: 7.8[3.6-13.8] and N: 7.2[3.6-13.8]). These results were similar when adjusted by body weight. Multivariate analyses demonstrated only young age as a significant factor for higher opioid use. However, the larger proportion of patients in Group C (46%) required minimal parenteral opioids post-PACU (≤3 mg morphine equivalent dose) as compared with Groups S (21%) and N (20%)(P=0.0410). Acetaminophen requirement was not different among the groups. The median[IQR] post-transplant length of stay was also similar (Groups C: 4.5[4-5.6], S: 4.5[4-5.5] and N: 5[4-6] days, P=0.4106).

CONCLUSION: These preliminary data suggest that single-shot TAP block provides no clinical benefits and continuous TAP block is beneficial only in a certain proportion of patients after kidney transplantation. Further studies are required to identify which patients benefit most from continuous TAP block.

CITATION INFORMATION: Sageshima J., Troppmann C., Santhanakrishnan C., McVicar J., Perez R. Continuous and Single-Shot Transverse Abdominis Plane (TAP) Block vs. Conventional Analgesia after Kidney Transplant Surgery Am J Transplant. 2017;17 (suppl 3).

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