BACKGROUND

The transversus abdominis plane (TAP) block reduces pain and opioid consumption following renal transplant surgery, but its impact on hospital length of stay (LOS) remains unclear. A novel Enhanced Recovery Pathway (ERP) for renal transplantation, focused around a pre-incision ultrasound-guided TAP block with 30 mL of 0.5% bupivacaine, was started in March 2016 at our institution. Other aspects of the pathway included: perioperative multimodal analgesia, accelerated resumption of diet, and early patient mobilization. We hypothesized that an ERP utilizing a TAP block will result in a reduction in LOS.

METHODS

With IRB approval, 136 consecutive charts prior to March 2016 (Pre-ERP cohort) and 136 consecutive charts after March 2016 (Post-ERP cohort) were retrospectively reviewed. The primary outcome was LOS following surgery completion.

RESULTS

Cohort demographic data is shown in Table 1. Mean LOS in the Post-ERP cohort was 5.2 ± 1.9 days and was significantly less than the 6.3 ± 3.5 days the Pre-ERP cohort averaged (P < 0.003). Secondary outcomes are shown in Table 2.

CONCLUSION

An ERP incorporating TAP blocks is associated with a clinical and statistical reduction in LOS as well as significant reduction in postoperative opioid consumption and pain scores. These findings support the analgesic efficacy of the TAP block but also suggest that these benefits extend beyond analgesia, improving recovery and discharge after surgery. Prospective studies are needed to confirm these results.

Table 1. Demographic Data

Pain = Average Pain Score on Numeric Rating Scale (NRS). Opioid = IV Morphine Equivalents (in mg) consumed.

CITATION INFORMATION: Peramunage D., Auyong D., Kuhr C., Brandenberger J., Cowan N., Hanson N. Enhanced Recovery after Renal Transplant Surgery Using a Transversus Abdominis Plane Block is Associated with Decreased Hospital Length of Stay Am J Transplant. 2017;17 (suppl 3).

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