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Transversus abdominis plane (TAP) block for laparoscopic live donor nephrectomy: Continuous catheter infusion provides no additional analgesic benefit over single-injection ropivacaine

Clin Transplant. 2020 Jun;34(6):e13861 doi: 10.1111/ctr.13861.

Video Review

Abstract

BACKGROUND:

Transversus abdominis plane (TAP) blocks are useful for adjunctive pain control following laparoscopic live donor nephrectomy (LLDN). The objective was to determine if TAP catheter provides additional analgesia compared with single-injection TAP block alone for kidney donors.

METHODS:

In this prospective, double-blinded, randomized controlled trial, LLDN patients received a single TAP injection of 30 mL 0.2% ropivacaine and had a catheter inserted into the TAP space. Postoperatively, either 0.2% ropivacaine (TAP catheter group; TAP-C) or saline (TAP saline group; TAP-S) was infused at 10 mL/h. Pain scores, narcotic usage, nausea, and sedation were evaluated at 1, 12, 24, 36, 48, and 60 hours.

RESULTS:

The study population included 70 patients (35 randomly assigned to each group). No differences in pain scores, narcotic usage, nausea, or sedation were observed at any time point (with the exception of lower median pain score for TAP-S at 60 hours; 3.2 vs 3.9 for TAP-C; P = .03).

CONCLUSIONS:

The lower pain score for placebo group at 60-hour postoperative is likely clinically insignificant. The TAP catheter infusion provided no benefit over a single-injection TAP block; thus, the added risk and cost are not supported. Liposomal bupivacaine should be evaluated in future studies.

CET Conclusion

Reviewer:	Mr John O'Callaghan, Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences University of Oxford
Conclusion:	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.

Reviewer:

Mr John O'Callaghan, Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences University of Oxford

Conclusion:

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.

Methodological quality

Jadad score	4
Allocation concealment	YES
Data analysis	PER PROTOCOL

Study Details

Aims:	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.
Interventions:	Patients were randomly assigned to either the active TAP-C (TAP catheter) group or the placebo TAP-S (TAP saline) group.
Participants:	70 laparoscopic live donor nephrectomy patients.
Outcomes:	The outcomes of interest were postoperative pain scores, narcotic (opioid) usage, scores for nausea and sedation, and patient satisfaction.
Follow Up:	60 hours

Metadata

Funding:	Non-industry funding
Publication type:	Randomized Controlled Trial, Randomised Controlled Trial
Organ:	Kidney
Language:	English
Author email:	yyeap@iupui.edu
MeSH terms:	Abdominal Muscles; Analgesics; Analgesics, Opioid; Catheters; Double-Blind Method; Humans; Laparoscopy; Living Donors; Nephrectomy; Pain, Postoperative; Prospective Studies; Ropivacaine; 0 (Analgesics); 0 (Analgesics, Opioid); 7IO5LYA57N (Ropivacaine); TAP Block; Analgesia; Catheter; Kidney; Transversus Abdominis Plane; Kidney Transplantation