Pd06-04 Intraoperative Transversus Abdominis Plane Blocks Reduce Post-Operative Opioid Usage: A Prospective, Randomized, Double-Blinded Trial

You have accessJournal of UrologyTransplantation & Vascular Surgery I (PD06)1 May 2024PD06-04 INTRAOPERATIVE TRANSVERSUS ABDOMINIS PLANE BLOCKS REDUCE POST-OPERATIVE OPIOID USAGE: A PROSPECTIVE, RANDOMIZED, DOUBLE-BLINDED TRIAL Michael D. Gross, William Jevnikar, Hannah Kerr, Venkatesh Krishnamurthi, Alvin Wee, Yi-Chia Lin, and Mohamed Eltemamy Michael D. GrossMichael D. Gross , William JevnikarWilliam Jevnikar , Hannah KerrHannah Kerr , Venkatesh KrishnamurthiVenkatesh Krishnamurthi , Alvin WeeAlvin Wee , Yi-Chia LinYi-Chia Lin , and Mohamed EltemamyMohamed Eltemamy View All Author Informationhttps://doi.org/10.1097/01.JU.0001008592.06852.43.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Post-operative recovery from kidney transplantation is often mired by limitations in multimodal analgesia as a result of pre-existing renal dysfunction. In this setting, opiates become the mainstay of post-operative pain management. Transversus Abdominis Plane (TAP) blocks provide abdominal wall analgesia and may reduce surgical site pain. We aim to determine the effectiveness of intraoperative surgeon administered TAP block administration for reducing post-operative opioid usage and pain in kidney transplantation patients. METHODS: Patients undergoing kidney transplantation via either a standard Gibson incision or the anterior rectus sheath (ARS) approach were randomized intraoperatively 1:1 to TAP block (a combination of liposomal and unbound bupivacaine) or normal saline via an injection by the operating surgeon into the reflected abdominal wall prior to bringing the kidney into the field. Patients, treating team, and survey team were blinded to randomization. Post-operative opioid usage, pain via dedicated survey, and length of stay for both groups were recorded. Differences between groups were calculated via t-test, χ2 and Mann Whitney U tests. RESULTS: Recruitment occurred from January 2022 to June 2023. There were 224 patients randomized and they were evenly distributed (Table 1). Median morphine milligram equivalents (MME) were significantly lower in patients receiving the TAP block (49 vs 75, p<0.001). MME was reduced with the TAP block in both the ARS (p=0.045) and Gibson subsets (p=0.001). Average pain and maximum pain scores were significantly lower in the TAP block group (Table 1). Length of stay did not differ between groups. 30 patients receiving a TAP block used no opiates while inpatient compared with 12 in the placebo arm (p=0.002). CONCLUSIONS: TAP block use resulted in a 35% reduction in post-operative opioid use and demonstrated lower pain levels. A quarter of patients receiving the TAP block required no opiates while inpatient, suggesting the possibility of opioid-free transplantation in select patients. Surgeon-administered TAP blocks are a worthy addition to a standardized transplant protocol with significant analgesic effect. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e161 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Michael D. Gross More articles by this author William Jevnikar More articles by this author Hannah Kerr More articles by this author Venkatesh Krishnamurthi More articles by this author Alvin Wee More articles by this author Yi-Chia Lin More articles by this author Mohamed Eltemamy More articles by this author Expand All Advertisement PDF downloadLoading ...