*Purpose: Living donor transplant programs are essential in decreasing the number of kidney wait-list candidates, however, of utmost importance should be ensuring our donors are provided the highest standard of care. This includes adequately treating acute surgical pain while protecting them from the adverse effects associated with opioid analgesics. Opioids while effective in treating acute pain can cause respiratory depression, sedation, nausea, constipation, and opioid dependence. Multimodal approaches to pain management have the potential to facilitate recovery while limiting opioid use. We hypothesized that the use of liposomal bupivacaine would decrease the amount of opioid utilization following living donor nephrectomy and limit the number of opioids on discharge.

*Methods: Between 2016 and 2019, living kidney donors were reviewed for opioid use following donation. Patients were grouped based on their approach to pain management over the years. Initially, patients were managed with patient controlled anesthesia out of the operating room, our control group. A bupivacaine transverse abdominis plane (TAP) block was used in the TAP group, a liposomal bupivacaine TAP block was used in the LB group. Lastly, patients who received liposomal bupivacaine TAP block and were limited to 10 tablets of an opioid on discharge were evaluated. Refills for opioids following discharge were tracked using a state-run controlled substance utilization, review and utilization system.

*Results: During the study period, 50 donors in the control, 96 in the TAP, 77 in the LB, and 48 in the limited tablets groups were evaluated. On post-operative day 0, the oral morphine equivalent was lower in the LB and TAP groups compared to control (4.4, 9.6, and 25.4mg, respectively, p<0.05) as well as on post-operative day 1 (15.7, 38.3, and 94.1mg respectively, p<0.05). Oral morphine equivalent was lower with LB compared to TAP (9.8 vs 22mg, p<0.05) on post-operative day 2 but not on post-operative day 3 (2.1 vs 8.2mg, p=NS). The amount of opioids prescribed at the time of discharge was lower in the LB group (135.4mg) compared to pre-ERAS (189.9mg) and TAP (158.9mg) in oral morphine equivalents. The majority of patients who received liposomal bupivacaine and were limited to 10 tablets on discharge did not require refills of opioids following discahrge.

*Conclusions: The use of bupivacaine or liposomal bupivacaine TAP block decreased the use of patient controlled analgesia and limited the number of opioids throughout hospitalization and on discharge. Patients discharged on opioids did not require refills following their hospitalization.

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