Transversus abdominis plane (TAP) block for laparoscopic live donor nephrectomy: continuous catheter infusion provides no additional analgesic benefit over single-injection ropivacaine.Yeap, Y. L., et al.
Clinical Transplantation 2020; e13861.
The aim of this study was to investigate whether transversus abdominis plane (TAP) catheter could provide additional analgesia benefit for kidney donors in comparison to single-injection ropivacaine TAP block alone.
Patients were randomly assigned to either the active TAP-C (TAP catheter) group or the placebo TAP-S (TAP saline) group.
70 laparoscopic live donor nephrectomy patients.
The outcomes of interest were postoperative pain scores, narcotic (opioid) usage, scores for nausea and sedation, and patient satisfaction.
This is a clearly written report of a good quality double-blind, randomised controlled trial. In both arms of the study an ultrasound-guided catheter was placed by an experienced anaesthetist. In one study arm normal saline infusion was attached and in another study arm 0.2% ropivacaine (10ml/H) infusion was attached. Alongside this all patients also had an intravenous morphine PCA. The catheter infusion was left in place for 48 hours before the patient was transitioned to oral analgesia. There was no significant difference in post-operative pain scores, apart from a very small difference at 60 hours and there was no significant difference in opioid use. The study was powered for a 60% reduction in opioid usage in 48 hours, which may mean that it is too small to identify a smaller but still clinically relevant difference. The concomitant use of morphine PCA is likely to have impacted on any potential difference in pain scores between the groups, although overall narcotic use was similar. This study does not support the use of continuous catheter infusion for analgesia in this patient group compared to US-guided TAP block.