TRANSVERSUS ABDOMINIS PLANE BLOCK CATHETERS FOLLOWING RENAL TRANSPLANTATION: A RETROSPECTIVE COHORT STUDY
Myhre, Calah1; Du, Katie1; Levine, Max2; Broomfield, Stacey2; Ip, Vivian3; Rasmussen, Andrew2
1 Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada;
2 Division of Urology, Department of Surgery, University of Alberta, Edmonton, Canada ;
3 Department of Anesthesia and Pain Medicine, Cumming School of Medicine, University of Calgary, Canada
Background
•The mainstay of analgesia in kidney transplantation is opioids via Patient-Controlled Analgesia (PCA) pumps.1,2
•
•The use of catheters to infuse local anesthetic within the Transversus abdominis plane (TAP) has been shown to enhance pain control and reduce opioid consumption.3
•
•Evidence on TAP catheter use in renal transplantation is limited.4
Methods
Study Design
•Retrospective cohort study of adult patients undergoing kidney transplantation between January 2020 to June 2023 at the University of Alberta Hospital
•Historical cohort of patients identified (time-based convenience sampling) acted as comparator group.
Outcomes
•Primary Outcome: Cumulative opioid consumption (oral morphine equivalents, mg) at 48 hours postoperatively.
•Secondary outcomes: Postoperative analgesic adjunct usage, PCA use, analgesic-related adverse events.
Analysis
•Descriptive and comparative statistics as appropriate.
Results
There was no significant difference in the opioid consumption at 48 hours between TAP and no-TAP groups (170 mg vs. 163 mg; p=0.86).
•PCA use was associated with increased opioid consumption (183 mg vs. 118 mg; p=0.007).
•
•More patients in the No TAP group received a PCA than the TAP group. (95.8% vs. 60.3%; p<0.001). After controlling for the influence of PCA (ANCOVA), there was no difference in opioid consumption between the two groups (169 mg vs. 141 mg; TAP vs. no TAP; p=0.272).
•No significant difference found in opioid consumption between transplant recipients who received a TAP catheter vs. those who did not at 48 hours.
•PCA use was associated with an increase in opioid consumption, PCA status did not influence opioid consumption between TAP and no-TAP groups.
•TAP catheter use appears safe in the renal transplant population.
•Role of TAP catheter remains unclear given heterogeneity of retrospective data.
•A randomized controlled trial is required to better determine the benefit, or lack thereof, for TAP catheter use in kidney transplantation.
•Patient reported outcomes are critical to define any possible benefit for TAP catheter use.
Acknowledgments
Stipend Support for Calah Myhre Provided by:
Dr. Rex Boake Studentship in Urology Award
References
1.Am J Transplant. 2018;18(12):2987-2999. doi:10.1111/ajt.14714
2.Am J Transl Res. 2021;13(6):7300-7305.
3.Pain Physician. 2021;24(5):345-358.
4.Br J Anaesth. 2010;104(5):663-664. doi:10.1093/bja/aeq077
5.Can J Anesth Can Anesth. 2022;69(8):1068-1069. doi:10.1007/s12630-021-02180-2
