Efficacy of Bilateral vs. Unilateral Transversus Abdominis Plane Blocks in Pain Control After Kidney Transplantation: A Retrospective Review 

Nathan Goergen, Valerie Shostrom, Nicholas Heiser, Arika Hoffman, Rafael Arsky Lombardi 

Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE 68198 

 

 

 Background/Introduction 

Incision made during kidney transplant causes substantial postoperative pain 

Transversus abdominis plane (TAP) block: a common regional anesthesia technique for truncal incision pain control 

Local anesthetic is injected between the internal oblique and transversus abdominis muscles with ultrasound guidance 

TAP blocks have decreased the need for narcotics, enhanced respiratory function, increased satisfaction, and facilitated mobilization and discharge.

 

 

Objective/purpose

Determine if laterality of block (bilateral vs. unilateral) plays a role in controlling pain from the unilateral incision made during kidney transplantation 

Compare patient pain scores and total opioid requirement 

Methods

A retrospective chart review evaluated the efficacy of bilateral (N=37) versus unilateral (N=46) TAP blocks 

85 kidney transplant recipients, Jan. 2021 through Jan 2024 

Inclusion criteria: age ≥ 19 yo 

Exclusion criteria (2 subjects excluded): o ASA > V 

o Emergent or redo surgeries 

o Opioid abuse disorder / chronic opioid use 

o Chronic pain conditions 

Results

First 12-hour post-op pain scores: Significantly lower (p=0.015) in bilateral (N=39) vs. unilateral (N=46) group overall o Pain scores significantly lower in males (p=0.002) in bilateral group (N=23) vs. unilateral group (N=25) 

1. o No significant difference for females (p=0.777) in bilateral (N=14) vs. unilateral (N=21) groups 
3. First 24-hour post-op pain scores: No significant difference (p=0.3917) between bilateral (N=37), unilateral (N=46) o Pain scores significantly lower in males (p=0.034) in bilateral group vs. unilateral group 
4. o No significant difference for females (p=0.355) 
6. 90 minutes, 12 hours post-surgery: No significant difference (p=0.050) in total group median pain scores o Pain scores significantly lower for males (p=0.029) in bilateral 
7. o No significant difference in females (p=0.655) 
9. 180 minutes, 24 hours post-surgery: No significant difference (p=0.543) in total group, males (p=0.218), or females (p=0.583) 
10. Total opioid requirement (MME): No significant difference in total groups (p=0.953), males (p=0.702), or females (0.751) 

Discussion/Conclusion

Our retrospective chart review demonstrated bilateral TAP blocks significantly reduce 12-hour pain scores compared to unilateral TAP blocks in adult kidney transplant recipients 

Pain scores in males were significantly reduced with bilateral TAP block in many timeframes analyzed 

Findings suggest bilateral TAP blocks may provider superior early postoperative analgesia during the first 12 hours after surgery 

Lack of significant difference in overall opioid consumption between the two groups highlights need for further research to determine clinical significance o Effect on overall impact to patient recovery remains to be studied 

 Further research needed to determine why bilateral TAP block more effective in males in terms of patient pain scores