Efficacy of the transversus abdominis plane block using 30 ml bupivacaine 0.25% in reducing postoperative fentanyl requirements in renal transplant recepients

Context Postoperative pain management for renal transplant recipients is limited by considerations related mainly to the impaired renal functions. Patient-controlled analgesia (PCA) by fentanyl has been used and provides good pain control. The transversus abdominis plane (TAP) block provides good postoperative analgesia for abdominal surgeries Aims The aim of the present study was to examine the efficacy of the TAP block using 30 ml bupivacaine 0.25% in reducing the postoperative fentanyl requirements in renal transplant recipients Patients and materials This double-blinded, prospective, randomized, controlled study included 50 patients divided into two equal groups: group A, the control group, which included patients who received the TAP injection with only normal saline and kept on PCA fentanyl; and group B, the TAP block group, which included patients who received the TAP block using 30 ml of bupivacaine 0.25% in addition to PCA fentanyl. The primary outcome was the postoperative 24 h fentanyl consumption, whereas other outcomes included pain scores, heart rate, mean arterial blood pressure, and incidence of nausea, vomiting, excessive sedation, and respiratory depression. Results Postoperative 24 h PCA fentanyl consumption was significantly lower in the TAP block group (330.9±36.8) compared with the control group (636.9±40) (P<0.01). The pain scores recorded in the TAP group were significantly lower (P<0.01). Mean arterial blood pressure was also significantly lower in the TAP group; however, differences between the recorded heart rates were nonsignificant (P=<0.01 and 0.6, respectively). None of the patients developed excessive sedation or respiratory depression. Conclusion A TAP block with 30 ml bupivacaine 0.25% provides excellent postoperative analgesia for renal transplant recipients and significantly reduced the 24 h postoperative PCA fentanyl requirements and the pain scores.