The transversus abdominis plane (TAP) block catheter for nephrectomy does not produce a significant decrease in opioid use in the first 48 hours after surgery, according to a study presented here at the 2018 Annual Meeting of the Canadian Anesthesiologists Society (CAS).
Jaasmit Khurana, BSc, University of Alberta, Edmonton, Alberta, presented the study on June 16.
A need exists for an effective strategy that prolongs pain control and decreases opioid reliance in kidney surgery. A TAP block catheter has been used in abdominal surgeries for analgesia as a replacement for thoracic epidurals.
“We want an approach that is easy to use and has an effect on postoperative pain,” explained Khurana.
The researchers retrieved data from 1,114 nephrectomy cases performed between 2005 and 2015 and assigned them as TAP cases or control (no TAP) cases.
“Our hypothesis is that we would see less opioid consumption [with TAP cases],” said Khurana, noting that patient-controlled analgesia was available to both groups of patients.
Patients were matched on their baseline characteristics, and investigators accounted for whether a radical or partial nephrectomy was performed. They also looked at measures such as pain scores, the incidence of nausea and vomiting, any other adverse events, and the time to ambulation.
A total of 156 charts were initially included, and 83 patients (41 TAP, 42 controls) were in the final analysis after propensity matching.
“Immediately after surgery, we found a significant difference in resting pain scores,” said Khurana, noting that the difference was observed at 16 to 32 hours after surgery.
A significant difference in the consumption of opioids was not observed between the study arms on days 1 and 2. Moreover, no differences in nausea and vomiting, length of stay, and time to ambulation were observed between the 2 groups.
A limitation of the investigation was its retrospective nature. A prospective investigation would likely have more robust capture of data overall and would capture adverse events, such as the development of haematomas, more accurately, concluded Khurana.
Analgesic Efficacy of Intraoperatively Placed Transverses Abdominis Plane (TAP) Block Catheter for Nephrectomy. Abstract 452722]