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

Yeap, Yar L; Wolfe, John W; Kroepfl, Elizabeth; Fridell, Jonathan; Powelson, John A

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 h. 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 h; 3.2 versus 3.9 for TAP-C; P = .03). CONCLUSIONS The lower pain score for placebo group at 60 h 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.