title: Continuous transversus abdominis plane block catheter analgesia for postoperative pain control in renal transplant.
abstract: OBJECTIVE
  Continuous transversus abdominis plane (TAP) block using a catheter has proven its usefulness in reducing opioid requirements and pain scores after lower abdominal surgery. However, there are no reports of its successful use after renal transplant. We tested the hypothesis that continuous TAP block would retrospectively reduce opioid requirement, nausea score and hospital stay after renal transplant surgery.
  
  
  METHODS
  In a retrospective study, we reviewed the data from 63 adult renal transplant recipients-31 with patient-controlled TAP analgesia with standing orders for intravenous as well as oral opioids as needed and 32 with intravenous patient-controlled analgesia. The TAP catheter was inserted preoperatively using an ultrasound-guided technique. Infusion of ropivacaine 0.2 % at 8 ml basal, 12 ml bolus and a lockout interval of 60 min were maintained for 48 h postoperatively. The primary outcome was total morphine-equivalent dose during the 48-h postoperative period. Secondary outcomes were pain and nausea scores for the 48-h postoperative period.
  
  
  RESULTS
  The mean 48-h postoperative morphine-equivalent doses [95 % confidence interval] for patient-controlled intravenous analgesia and TAP catheter were 197 [111, 349] and 50 [28, 90], respectively, which were significantly different (P = 0.002). The mean 48-h average verbal response pain scores were 2.94 [2.39, 3.50] and 2.49 [1.93, 3.06], respectively, which were not significantly different (P = 0.26). The mean nausea scores were 0.66 [0.46, 0.87] and 0.60 [0.40, 0.81], respectively, which were not significantly different (P = 0.69). There was no difference regarding hospital stay.
  
  
  CONCLUSIONS
  The use of continuous TAP analgesia for postoperative analgesia after renal transplant was effective in reducing the morphine-equivalent requirements.
authors.affiliation: Departments of General Anesthesiology and Outcomes Research, Cleveland Clinic, 9500 Euclid Avenue/E31, Cleveland, OH, 44195, USA, farage@ccf.org.
authors.forename: Ehab
authors.initials: E
authors.lastname: Farag
authors.forename: Maged N
authors.initials: MN
authors.lastname: Guirguis
authors.forename: Mada
authors.initials: M
authors.lastname: Helou
authors.forename: Jarrod E
authors.initials: JE
authors.lastname: Dalton
authors.forename: Fallon
authors.initials: F
authors.lastname: Ngo
authors.forename: Michael
authors.initials: M
authors.lastname: Ghobrial
authors.forename: Jerome
authors.initials: J
authors.lastname: O'Hara
authors.forename: John
authors.initials: J
authors.lastname: Seif
authors.forename: Venkatesh
authors.initials: V
authors.lastname: Krishnamurthi
authors.forename: David
authors.initials: D
authors.lastname: Goldfarb
mesh_terms: D000005:Abdomen / Q000601:surgery; D000009:Abdominal Muscles; D000328:Adult; D000368:Aged; D000577:Amides / Q000008:administration & dosage; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000188:drug therapy*; D012189:Retrospective Studies; D000077212:Ropivacaine
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D009020:Morphine; D000077212:Ropivacaine