Comparison of Three-Quadrant Transversus Abdominis Plane Block and Continuous Epidural Block for Postoperative Analgesia After Transperitoneal Laparoscopic Nephrectomy

Abstract

Background: Postoperative pain management is important for the early recovery of the living donor patient. Patient-controlled opioid analgesia, epidural analgesia, or a combination of both is the preferred pain management after abdominal surgery although these approaches have serious side effects. The transversus abdominis plane (TAP) block has been increasingly used for postoperative pain management and the addition of dexamethasone to local anesthetic can prolong the duration of action.

Objectives: This study evaluated the efficacy of ultrasound-guided three-quadrant TAP block analgesia with the addition of dexamethasone, compared to the continuous epidural analgesia in postoperative cumulative opioid consumption and pain scale in the first 24 hours following transperitoneal laparoscopic living donor nephrectomy.

Methods: A prospective randomized control study was conducted on 50 patients with ASA I-II, 18 - 65 years old, BMI 18 - 30, and undergoing transperitoneal laparoscopic donor nephrectomy under general anesthesia. The patients were randomly assigned into either a three-quadrant TAP block group (n = 25) with 20 mL of 0.25% bupivacaine plus dexamethasone 8 mg or a continuous epidural group (n = 25) using 0.125% bupivacaine postoperatively. The morphine consumption and the numerical rating scale (NRS) at rest and movement were evaluated at 2, 6, 12, and 24 hours postoperatively. The postoperative first-time mobilization and duration of urinary catheter usage were recorded.

Results: Patients demographic characteristics were similar in the two groups. During 24 hours after the surgery, cumulative morphine consumption (P = 0.232), the NRS at rest and movement (P > 0.05), and the first-time mobilization (P = 0.075) were not significantly different between the groups, except that the NRS during movement at 12 hours was significantly lower in the TAP block group (P = 0.004). The duration of urinary catheterization was significantly longer as a side effect in the continuous epidural group (P < 0.001).

Conclusions: The three-quadrant TAP block with the addition of dexamethasone showed comparable analgesic effects as the continuous epidural analgesia in cumulative opioid consumption and pain scale in the first 24 hours following transperitoneal laparoscopic donor nephrectomy.

Keywords: Continuous Epidural Block; Laparoscopic Nephrectomy; Pain Management; Transversus Abdominis Plane Block.

Conflict of interest statement

Financial Disclosure:Dr Dita Aditianingsih as the author and main corresponding author represented all the authors in this manuscript, stated that we have no financial interests related to the material in the manuscript.

Figures

Figure 1.. The TAP block technique, posterior injection (A), an ultrasound image of the posterior approach (B), subcostal injection (C), an ultrasound image of the subcostal approach (D). EO, external oblique muscle; IO, internal oblique muscle; RA, rectus abdominis muscle; TAM, transversus abdominis muscle.

Figure 2.. Study consolidated standards of reporting trials (CONSORT) flowchart

Figure 3.. Comparison of postoperative morphine consumption and the time of first PCA attempt. Gray box represents the TAP group and white box represents the epidural group. The horizontal lines indicate the medians, boxes indicate interquartile ranges, and whiskers indicate ranges. The P values are presented in median (minimum - maximum), P