Background

Renal transplant recipients have limitations in pain management, given the nephrotoxicity of NSAIDS and contraindications to regional neuroaxial techniques. Although opioids are widely used post-transplant, they have significant side-effects. TAP catheters have shown reduction of pain and opioid consumption in other abdominal procedures.

Methods

53 kidney recipients who underwent TAP catheter placement between March-Sept 2017, were compared to 448 historical recipients between July 2015–Feb 2017. We excluded re-transplants with midline/ipsilateral incisions, dual-kidneys and combined transplants. Catheters were placed during abdominal wall closure between the internal oblique and transversus abdominal muscles. Continuous infusion of 0.2% ropivacaine with a rate of 10 ml/hr was administered via TAP catheter and removed on POD3. Both groups had the same access to IV PCA and PO pain meds. We recorded pain scores with visual analog scale (0=no pain, 10=worst pain ever) at rest and activity at standard time points as well as total opioid consumption during their hospital stay.

Results

There were no significant differences in age, gender, race or donor type between TAP and No-TAP groups. At rest, TAP patients had significantly lower pain scores at 12, 24, 36 and 48 hrs post-transplant (3.1, 2.5, 2.1, 2.1 vs. 3.7, 3.3, 2.8, 2.8 respectively, p<0.023). On activity, pain was significantly improved at the same time-points (4.5, 4.2, 3.9, 3.3 vs. 5.2, 4.9, 4.5, 4.3, p<0.003). Cumulative opioid consumption in morphine milligram equivalents (MME) were significantly lower in TAP patients at 24, 48, 72 hrs and 7 days (21.1, 48.1, 73.2, 111.9 vs. 66.7, 108.0, 139.8, 190.2, p<0.004). Post-transplant length of stay was lower in the TAP group, although not statistically significant (4.9+3.1 vs. 5.3+2.9). No surgical complications related to the procedure were seen.

Conclusions

Surgical placement of TAP catheters is safe, effective, and significantly decreases post-transplant pain by 25% during the first 4 days and total opioid consumption by 55.5% during the first 48 hrs and 41.1% during the first week. More attempts should be made to integrate regional anesthesia techniques in the transplant population.

CITATION INFORMATION: Dib M., Borden S., Schell T., Stahler P., Al-Qaoud T., Martinez E., Grodstein E., D'Alessandro A., Odorico J., Fernandez L., Mezrich J., Redfield R., Foley D., Al-Adra D., Kaufman D. Use of Surgically Placed Transversus Abdominis Plane (TAP) Block Catheter with Local Anesthetic Infusion in Renal Transplantation Am J Transplant. 2017;17 (suppl 3).

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