E. W. Kabil1, P. Baliga1, D. Taber1, E. S. Clemmons1, K. Chavin1 1Medical University Of South Carolina,Transplant Surgery,Charleston, Sc, USA
Introduction: Prior research demonstrates that patients with a transversus abdominis plane (TAP) block may require less combined oral and intravenous narcotics compared to patients without a TAP block after a Laparoscopic Donor Nephrectomy (LDN), but are limited by size and scope and follow-up.
Methods: This was a retrospective analysis to compare the narcotic analgesic requirements and clinical outcomes of patients who underwent a TAP block procedure compared to patients that received usual care, consisting of a local wound infiltration with Marcaine 0.05%. Adult donors undergoing surgery between 2010 and 2013 were included. The primary endpoint was the amount of narcotic analgesics (measured in morphine equivalents) required by patients postoperatively until discharge home. Secondary endpoints included post-operative day 1 serum creatinine, hospital length of stay, and complications.
Results: 60 patients, 15 (25%) of which received TAP, were included in the analysis. Baseline demographics were similar between groups. There was a trend in reduced in-hospital morphine equivalents (ME) use in the TAP group (median of 31.30 mg in the TAP group versus 40.00 mg in the usual care group, p = 0.164). Hospital length of stay was similar for both groups (median of 3 days, p = 0.722). Serum creatinine level on post-operative day 1 was slightly lower in the TAP group (median of 1.2 mg/dL in the TAP group versus 1.3 mg/dL in the usual care group, p = 0.064). Overall complication rates were significantly less in the TAP group, with zero complications in the TAP group versus 13 in the usual care group, p = 0.0187.
Conclusion: ME use was less in the TAP group but the difference was not statistically significant. However, the power of this study (calculated to be approximately 20%) was limited by the low number patients in the TAP group. The clinical significance of these findings warrants further investigation, as evidence of an improvement in pain control of live donor patients will help to alleviate a signficant disincentive to donation.
