Reducing Opioid Dependence and Improving Patient Experience for Living Kidney Donors with Transversus Abdominis Plane Block
Open Access
- 25 February 2021
- journal article
- research article
- Published by MDPI AG in Transplantology
- Vol. 2 (1), 57-63
- https://doi.org/10.3390/transplantology2010006
Abstract
Rapid recovery after laparoscopic living donor nephrectomy (LLDN) for kidney donation is highly desirable for living kidney donors. To uphold rapid recovery, good analgesia with minimal adverse effects, including those related to opioid dependence, is essential. A pre-operative transversus abdominis plane (TAP) block with liposomal bupivacaine can effectively aid in perioperative pain management, while reducing opioid requirements. We conducted a single-center retrospective study involving patients 18 years and older who underwent LLDN to determine whether a TAP block with liposomal bupivacaine is efficacious in pain management after LLDN, while reducing opioid use. The study group comprised of patients who received a preoperative TAP block with liposomal bupivacaine in place of hydromorphone patient-controlled analgesia (PCA) and the control group included patients who received hydromorphone PCA post-operatively. Both groups were supplemented with oral and intravenous analgesics for breakthrough pain, as needed. The primary endpoint was reduction in post-operative opioid use in morphine milligram equivalents (MME). Secondary endpoints included: post-operative pain scores, postoperative length of stay, and re-hospitalizations within 7 days of discharge. Sixty-six patients were included in our study, with 33 in each group. Patients in both groups were well matched demographically. The study group who received TAP block demonstrated a significant reduction in post-operative opioid use (92.05 MME vs. 53.98 MME, p < 0.05) when compared to the control group who received hydromorphone PCA. Both groups achieved similar analgesia with comparable pain scores. There was no difference between postoperative hospital lengths of stay for both groups. Two patients in the control group were re-admitted due to small bowel obstruction within seven days of discharge. In conclusion, TAP block with liposomal bupivacaine significantly reduced postoperative opioid use, while also proving to be safe, efficacious and feasible in patients undergoing LLDN.Keywords
This publication has 13 references indexed in Scilit:
- Prospective, double-blind, randomized clinical trial comparing an ERAS pathway with ketorolac and pregabalin versus standard of care plus placebo during live donor nephrectomy for kidney transplantAmerican Journal of Transplantation, 2018
- Transversus abdominis block utilizing liposomal bupivacaine as a non-opioid analgesic for postoperative pain managementSurgical Endoscopy, 2018
- Analgesic efficacy of laparoscopic-guided transverse abdominis plane block using liposomal bupivacaine in bariatric surgeryThe American Journal of Surgery, 2018
- Intravenous Acetaminophen for Postoperative Pain Management in Patients Undergoing Living Laparoscopic Living-Donor NephrectomyAnnals of Pharmacotherapy, 2016
- Laparoscopic versus open nephrectomy for live kidney donorsCochrane Database of Systematic Reviews, 2011
- Causes and Consequences of Inadequate Management of Acute PainPain Medicine, 2010
- Morbidity and Mortality After Living Kidney Donation, 1999-2001: Survey of United States Transplant CentersAmerican Journal of Transplantation, 2003
- Parenteral Ketorolac: The Risk for Acute Renal FailureAnnals of Internal Medicine, 1997
- Parenteral Ketorolac and Risk of Gastrointestinal and Operative Site BleedingJAMA, 1996