The analgesic efficacy of continuous transversus abdominis plane block in renal transplant recipients

Abstract

Background and Aims:Transversus abdominis plane (TAP) block is suitable for operations where parietal pain is a major cause of pain. Renal transplant recipients are ideally suited to gain maximum benefit from TAP block as the incision classically involves the lower abdomen. This study was conducted to evaluate the analgesic efficacy of continuous TAP block in transplant recipients.Material and Methods:In a prospective double-blind study, 40 chronic renal failure patients undergoing open renal transplant were randomly divided into two groups. At the end of surgery during closure, a multiorifice epidural catheter was placed in TAP plane. Study group (Group S) received Inj bupivacaine bolus 1 mg/kg (0.25%) followed by infusion 0.25 mg/kg (0.125%) through the catheter, whereas control group (Group C) received normal saline through the catheter. Inj pentazocine (0.3 mg/kg) was given as rescue analgesic at visual analogue score (VAS) > 3 in any group at rest or on movement. The analgesic efficacy was judged by VAS, time of first rescue analgesic, and total analgesic consumption in 24 h.Results:Patients in Group S had significant lower VAS scores, longer time to first rescue analgesic (270 ± 347.96 vs. 42.85 ± 32.27 min) and lower pentazocine consumption (9.75 ± 13.95 vs. 56.42 ± 12.46 mg) in 24 h. There was significant sedation in Group C.Conclusion:The TAP catheter technique for postoperative pain control after renal transplant has proved to be effective in relieving the postoperative pain after renal transplant with less pentazocine requirement and less sedation.

Transversus Abdominis Plane Catheters for Analgesia Following Abdominal Surgery in Adults

“…2). Of the 12 included trials, only 4 trials 17,19,22,25 used participant blinding, and only 6 trials 17,19,[22][23][24][25] were blinded on outcome assessment. Publication of study protocols prior to trial commencement was inconsistent among the selected trials.…”

Opioid Sparing Anaesthesia for Living-Donor Renal Transplantation-A Case Report

“…It has a high margin of safety and is technically simple to perform, especially under ultrasound guidance [5,8]. The TAP block decreases the need for intraoperative analgesia, but due to the long duration of surgery, the analgesic effect of the block fades, and it does not reduce morphine requirements postoperatively, according to randomized controlled trials [9,10].…”

“…Non-steroidal anti-inflammatory drugs inhibit prostaglandins synthesis, which are important for autoregulation of renal blood flow and glomerular filtration rate, therefore, these drugs are contraindicated in such clinical situations [5,6]. Local anaesthetic infiltration is not the most effective treatment in relieving deep muscle pain [5]. Epidural analgesia could be a choice, but it causes excessive analgesia, since the incision is in the lower abdomen and causes mild to moderate pain, and there is the risk of neuroaxial complications [4,5].…”

“…Inadequately controlled pain can lead to agitation, tachycardia, hypertension and increased risk of pulmonary complications [4]. Non-steroidal anti-inflammatory drugs inhibit prostaglandins synthesis, which are important for autoregulation of renal blood flow and glomerular filtration rate, therefore, these drugs are contraindicated in such clinical situations [5,6]. Local anaesthetic infiltration is not the most effective treatment in relieving deep muscle pain [5].…”

“…Local anaesthetic infiltration is not the most effective treatment in relieving deep muscle pain [5]. Epidural analgesia could be a choice, but it causes excessive analgesia, since the incision is in the lower abdomen and causes mild to moderate pain, and there is the risk of neuroaxial complications [4,5].…”