Comparison of methods of providing analgesia after pancreas transplant: IV opioid analgesia versus transversus abdominis plane block with liposomal bupivacaine or continuous catheter infusion

Abstract

Background: Current practices emphasize a multimodal approach to perioperative analgesia due to higher efficacy and decreased opioid usage. Analgesia for pancreas transplant (PT) has traditionally been managed with intravenous (IV) opioids, and reports of transversus abdominis plane (TAP) blocks are limited in this population.Methods: Three interventions were compared in adult PT patients, including IV opioids, TAP catheter, and TAP block with liposomal bupivacaine. Time to return of intestinal function and oral diet, postoperative pain scores, opioid usage, and length of stay were recorded.Results: Study included 197 PT patients: 62 (32%) standard care, 90 (45%) TAP catheters with continuous 0.2% ropivacaine, and 45 (23%) single liposomal bupivacaine TAP block. Pain scores were lowest for the IV opioid group (P < 0.001). The liposomal bupivacaine group had lower pain scores on postoperative days (POD) 1-5 than the TAP catheter group. Opioid use during POD 1-5 was lower for both TAP block groups (P = 0.03). Time to bowel function was faster for the TAP block groups (P < 0.05).Conclusions: Compared with IV opioid analgesia, TAP block interventions were associated with lower overall use of opioids and a faster time to intestinal function following pancreas transplant. K E Y W O R D Smultimodal, postoperative, regional analgesia, ropivacaine, TAP block

Randomized Prospective Study Evaluating Single-Injection Paravertebral Block, Paravertebral Catheter, and Thoracic Epidural Catheter for Postoperative Regional Analgesia After Video-Assisted Thoracoscopic Surgery

“…This may be owing to the high-volume nature of the PVB block; therefore, continuous infusion of 10 mL/h might be less effective in providing analgesia. 24 Given these results, and the faster placement time for single-injection PVB, the authors would favor using the single-injection PVB for any patients who are not ideal candidates to receive TEA. Future studies might examine the use of liposomal bupivacaine in the PVB to determine if longer duration analgesia can be provided.…”

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

“…Our findings that TAP catheters are not superior to single‐injection TAP blocks are likely relevant to other abdominal surgeries. A recent study showed that a single TAP block of liposomal bupivacaine produced lower pain scores after pancreas transplant compared with ropivacaine by TAP catheters 16 . Transversus abdominis plane catheters were also shown to be less effective than thoracic epidural analgesia for incisional hernia repair 17 .…”

Abdominal Organ Transplantation: Noteworthy Literature in 2019

“…Yeap et al conducted a retrospective, single-center study of 197 pancreatic transplants performed from 2009 to 2017 and compared 3 interventions: intravenous (IV) opioids (N ¼ 62, 32%), transversus abdominus plane (TAP) catheter with continuous 0.2% ropivacaine (N ¼ 89, 45%), and single-shot TAP block with liposomal bupivacaine (N ¼ 46, 23%). 1 Immediate postoperative pain scores were lowest for the IV opioid group (P < .001); however, opioid use during postoperative days (PODs) 1 to 5 was lower for both TAP block groups (mean [SE] required daily morphine equivalents in mg were 113 [18.6], 90 [7.5], and 63 [6.8] for standard care, TAP catheter, and liposomal bupivacaine groups, respectively, P ¼ .03). Time to bowel function was faster for the TAP block groups (P < .05) than for the IV opioid group, with times to first oral intake of 12 and 14 hours versus 26 hours (P < .001).…”

“…This evidence supports integration of TAP blocks into a multimodal analgesic plan for postoperative pain control after pancreatic transplantation and may allow for decreased opioid use and faster intestinal recovery. 1…”