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.
Highlights
Living kidney donation has significantly and gradually increased in the United States, with 6867 donations being performed in 2019 [1]
The primary objective of the study was to determine if transversus abdominis plane (TAP) block with liposomal bupivacaine could safely reduce post-operative opioid use after Laparoscopic living donor nephrectomy (LLDN) and still achieve comparable postoperative analgesia
Our study concludes that TAP block significantly reduced postoperative opioid use, while achieving similar, efficacious and safe post-operative pain control
Summary
Living kidney donation has significantly and gradually increased in the United States, with 6867 donations being performed in 2019 [1]. Technical advancement from an open to minimally invasive approach has impactfully contributed to the increased organ donation efforts by living kidney donors. Laparoscopic living donor nephrectomy (LLDN), first adopted in 1995 [2], is considered a standard surgical approach for kidney donation due to the decreased morbidity, mortality, and better recovery when compared to open nephrectomy [3]. Benefits of such a minimally invasive approach are largely due to better pain management. Despite the technical advantage of LLDN, its benefits are not fully utilized, as patients still require opioids for optimal pain management [4], most of whom are opioid-naïve and would not be exposed to opioids if not for the kidney donation.
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