*Purpose: Post-operative pain management is crucial in determining early morbidity after major abdominal surgery. Opioid use may contribute to worsened gastroparesis and intestinal dysmotility in diabetics. The study compares use of traditional opiods to Liposomal bupivacaine injection versus continuous catheter injection in transversus abdominis plane (TAP) in pancreas transplant recipients.

*Methods: A retrospective chart review of patients undergoing pancreas transplant between 2009 and 2017 was done to identify patients for study. Those with peri-operative bowel or organ injury, current daily opioid use ≥ 30 mg PO morphine equivalent, diagnosed chronic pain syndrome, or known history of substance abuse within 3 months of surgery and contraindication to TAP block were excluded. A total of 196 patients were included in the study, 45 received single shot liposomal bupivacaine TAP block, 90 received TAP catheters with continuous 0.2% ropivacaine, and 61 receiving only IV opioids.

Data obtained included demographics, pain intensity scores from post-op day 0 to day of discharge, opioid usage, time to first flatus, time to first bowel movement, length of hospital stay, and occurrence of opioid-related side effects including nausea, vomiting, respiratory depression, pneumonia, and aspiration.

*Results: Patients who received either TAP block or catheter had a significant reduction of daily and total opioid consumption during POD 1-5 in comparison to patients receiving only IV opioids. When comparing to the group receiving no TAP intervention, the average daily dose of opioids was almost halved in the liposomal bupivacaine group and decreased by about 20% in the TAP catheter group. Those receiving only IV opioids for pain control reported significantly improved pain scores in comparison to both TAP block interventions during POD 1-5. Liposomal bupivacaine group showed significantly better pain scores than the continuous TAP catheter group over POD 1-5. Patients receiving continuous TAP infusions had significantly the least amount of time to return of bowel function measured by first stool output. Patients receiving either TAP intervention had significantly decreased time to first oral intake in comparison to the IV opioid-managed group. There was no significant difference in length of stay, post-operative nausea and vomiting, or other opioid-related side effects between the three groups.

*Conclusions: TAP interventions such as blocks may provide acceptable post-operative analgesia in pancreas transplant recipients. They may reduce total daily opioid use and lead to decreased time to return of bowel function than when only IV opioids are used.

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