Randomized clinical trial of transversus abdominis plane block versus placebo control in live-donor nephrectomy.
BACKGROUND
Laparoscopic surgery reduces pain after donor nephrectomy; however, most patients still require a significant amount of postoperative parenteral opiate analgesia. Therefore, there is a need to investigate techniques that might further reduce postoperative pain. This study assessed the safety and efficacy of using a transversus abdominis plane (TAP) block in a randomized, double-blind, placebo-controlled trial.


METHODS
Forty-six patients were analyzed in the trial and were randomized to undergo the TAP block procedure with either bupivacaine (n=24) or saline placebo (Control n=22) injected into the muscle plane. Prefilled syringes were dispensed with the group allocation concealed to maintain blinding. After surgery, the amount of morphine, level of pain, and measures of recovery were recorded.


RESULTS
The amount of morphine used 6 hr after surgery was significantly lower in patients receiving TAP block with bupivacaine compared with the control (presented as mean [SD], 12.4 [8.4] vs. 21.2 [14.0] mg; P=0.015). However, the total amount of morphine used was similar in both groups 45.6 [31.4] vs. 52.7 [28.8] mg; P=0.771. Patients in the bupivacaine group experienced significantly less pain on postoperative days 1 (score, 19 [15] vs. 37 [20]; P=0.003) and 2 (score, 11 [10] vs. 19 [13]; P=0.031). Recovery and postoperative hospital stay were similar in both groups. There were no complications associated with the procedure.


CONCLUSIONS
The TAP block procedure is beneficial in reducing postoperative pain and early morphine requirements in laparoscopic live-donor nephrectomy.
Department of Infection, Immunity, and Inflammation, Transplant Group University of Leicester, Leicester, UK. sarahhosgood@hotmail.com
Sarah A
SA
Hosgood
Umasanker M
UM
Thiyagarajan
Harriet F L
HF
Nicholson
Inthira
I
Jeyapalan
Michael L
ML
Nicholson
D034861:Abdominal Wall / Q000294:innervation*; D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local; D002045:Bupivacaine; D004311:Double-Blind Method; D004739:England; D005260:Female; D018737:Hand Strength; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D010535:Laparoscopy / Q000009:adverse effects; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D009043:Motor Activity; D009392:Nephrectomy / Q000009:adverse effects; D009407:Nerve Block; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D010919:Placebos; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D010919:Placebos; D009020:Morphine; D002045:Bupivacaine