Purpose: Post-operative pain management is of major concern in living donor nephrectomy patients. Opioids are often used for post-surgical pain, however they are associated with a myriad of side effects including nausea, vomiting, constipation and respiratory depression. In addition, a concerted effort must be made to minimize opioid use in the wake of the ongoing United States opioid epidemic. Ultrasound-guided transverse abdominis plane block (TAP-block) using bupivacaine provides a potential mechanism of analgesia without the use of opioids. We retrospectively examined the efficacy of TAP-block compared to a historical control cohort, and hypothesized that the use of TAP-bock would decrease post-surgery opioid consumption.

Methods: Daily opioid consumption for post-op day (POD) 0 and 1, and mean morphine equivalents (MEQ) per day were collected. All opioid doses were converted to oral MEQ for comparison. TAP-block data was collected on all patients for the 6 months post implementation and compared to a historical control cohort of an equal period of time. All donors were included in the study. Analyses of opioid consumption were performed using a multivariate linear regression for significant effectors, with TAP-block forced into the model.

Results: Donor data was available for 53 TAP-block patients and 41 control patients. Multivariate analysis demonstrated no significant analgesia benefit in MEQ reduction on POD 0 (P=0.702) or mean MEQ per day (P=0.112), and TAP-block patients trended towards a greater MEQ requirement on POD 1 (P=0.069). Female gender was associated with less MEQ on POD 0 (P=0.004), POD 1 (P=0.002) and mean MEQ per day (P<0.001). In addition, receiving an opioid prescription 6 months prior to donation was associated with a greater mean MEQ per day (P=0.004). Use of acetaminophen, gabapentin, lidocaine or ketorolac did not have a significant effect.

Conclusion: In the largest study of TAP-block use in donor nephrectomy, the use of TAP-block was not associated with a decrease in MEQ use, however female patients use less MEQ, and donors who received a prescription for a narcotic in the previous 6 months is associated with greater MEQ use. This information may be useful in tailoring analgesia post-donation. Further research must be performed to determine a more efficacious post-surgical pain strategy in living donor nephrectomy patients.

CITATION INFORMATION: Henricksen E., Quan D., Freise C. Opioid Use Following Ultrasound-Guided Transverse Abdominis Plane Blocks in Living Donor Nephrectomy Patients Am J Transplant. 2017;17 (suppl 3).

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