Positive Implications of an Enhanced Recovery after Surgery Protocol Using Liposomal Bupivacaine for Transverse Abdominis Plane Block in the Perioperative Phase of Robotic Assisted Laparoscopic Living Donor Nephrectomy
1Dept. of Surgery, University of Virginia Health System, Charlottesville, VA
2ERAS Program, University of Virginia Health System, Charlottesville, VA
3Strickler Transplant Institute, University of Virginia Health System, Charlottesville, VA
4Dept. of Internal Medicine, University of Virginia Health System, Charlottesville, VA
5Dept. of Anesthesiology, University of Virginia Health System, Charlottesville, VA.
Meeting: 2018 American Transplant Congress
Abstract number: C126
Keywords: Donation, Kidney, Laparoscopy, Pain
Session Information
Session Name: Poster Session C: Kidney Living Donor Issues
Session Type: Poster Session
Date: Monday, June 4, 2018
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
Introduction. Enhanced Recovery After Surgery (ERAS) protocols aim to mitigate the physical and psychological stress response to surgery. Postop pain can increase the need for opioid analgesia, delaying recovery and prolonging hospitalization. Here, we examined the implementation of an ERAS protocol for robotic assisted laparoscopic living donor nephrectomy with emphasis on the periop administration of liposomal bupivacaine (EXPAREL). Methods. All living donors were assigned and educated to undergo our institutional ERAS protocol. Donors were consented and divided into 3 groups regarding the use of EXPAREL: subfascial injection by surgeon at the time of wound closure (SF-EXP), TAP block by anesthesiologist right after the intubation (TAP-EXP), and no EXPAREL (no-EXP). Opioid (morphine sulfate equivalents) requirement, postop pain scores and length of hospital stay (LOS) were used as efficacy endpoints. Results. 23 healthy living donors underwent robotic assisted laparoscopic nephrectomy (7 SF-EXP, 8 TAP-EXP, 8 no-EXP) between June and October 2017. All donors were discharged home on postop day (POD) 1 to 4 with no complications. The average LOS (days) was lower in TAP-EXP (2.0) compared to SF-EXP (2.9) or no-EXP (2.4) (p=.04). TAP-EXP also required less intraop opioid (mean of 5.5 mg vs 14.2 mg vs 9.7 mg in TAP-EXP vs SF-EXP vs no-EXP, respectively (p=.01). TAP-EXP also required less postop opioid (mean of 18.7 mg vs 48.9 mg vs 41.5 mg in TAP-EXP vs SF-EXP vs no-EXP, respectively). However, the difference only reached the statistical significance when comparing the medians (p=0.04), and not the means (p=0.14). The highest and the average postop pain scores were not different between the 3 groups. Conclusion. The use of TAP-EXP within the context of ERAS program for robotic assisted laparoscopic living donor nephrectomy is safe and feasible, and reduces LOS and periop opioid requirement.
CITATION INFORMATION: Nickkholgh A., Agarwal A., Sarosiek B., Sites A., Nishio Lucar A., Oberholzer J., Amato P. Positive Implications of an Enhanced Recovery after Surgery Protocol Using Liposomal Bupivacaine for Transverse Abdominis Plane Block in the Perioperative Phase of Robotic Assisted Laparoscopic Living Donor Nephrectomy Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Nickkholgh A, Agarwal A, Sarosiek B, Sites A, Lucar ANishio, Oberholzer J, Amato P. Positive Implications of an Enhanced Recovery after Surgery Protocol Using Liposomal Bupivacaine for Transverse Abdominis Plane Block in the Perioperative Phase of Robotic Assisted Laparoscopic Living Donor Nephrectomy [abstract]. https://atcmeetingabstracts.com/abstract/positive-implications-of-an-enhanced-recovery-after-surgery-protocol-using-liposomal-bupivacaine-for-transverse-abdominis-plane-block-in-the-perioperative-phase-of-robotic-assisted-laparoscopic-living/. Accessed May 13, 2025.« Back to 2018 American Transplant Congress