PD31-01 IMPACT OF TRANSVERSUS ABDOMINUS PLANE NERVE BLOCK DURING KIDNEY TRANSPLANTATION ON PATIENT POST-OPERATIVE OPIOID USAGE: A PROSPECTIVE, RANDOMIZED, DOUBLE-BLINDED STUDY

Abstract

You have accessJournal of UrologyCME1 Apr 2023PD31-01 IMPACT OF TRANSVERSUS ABDOMINUS PLANE NERVE BLOCK DURING KIDNEY TRANSPLANTATION ON PATIENT POST-OPERATIVE OPIOID USAGE: A PROSPECTIVE, RANDOMIZED, DOUBLE-BLINDED STUDY William Jevnikar, Michael Gross, Hannah Kerr, Venkatesh Krishnamurthi, Alvin Wee, Yi-Chia Lin, and Mohamed Eltemamy William JevnikarWilliam Jevnikar More articles by this author , Michael GrossMichael Gross More articles by this author , Hannah KerrHannah Kerr More articles by this author , Venkatesh KrishnamurthiVenkatesh Krishnamurthi More articles by this author , Alvin WeeAlvin Wee More articles by this author , Yi-Chia LinYi-Chia Lin More articles by this author , and Mohamed EltemamyMohamed Eltemamy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003324.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Kidney transplantation is a life-altering procedure with excellent surgical outcomes. However, options for post-operative analgesia are limited by pre-existing renal dysfunction and most centers rely heavily on opioids for pain control. Transversus Abdominus 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 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 the reflected abdominal wall prior to bringing the kidney into the field. Patients and treating 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: 128 patients were randomized and were evenly distributed (Table 1). Patients receiving the TAP block required fewer morphine milligram equivalents (MME) (30.0 vs 60.3, p=0.002) and had a lower maximum pain score (6 vs 7, p=0.039) compared to placebo. MME was reduced with TAP in both the ARS (p=0.024) and Gibson subsets (p=0.020). 27 of the patients receiving an ARS incision used no opiates while inpatient, with significantly more patients having received the TAP vs placebo (20 vs 7, p=0.001). CONCLUSIONS: TAP block reduced MME usage by half for each surgical approach. 26% of the cohort did not require any opioids following transplantation including half of all patients receiving the combination of ARS and TAP block. The TAP block is an easily-implemented adjunct with the ability to significantly decrease the post-operative opioid use in renal transplantation with the additional possibility of opioid-free transplantation in select patients. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e900 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information William Jevnikar More articles by this author Michael Gross 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 ...