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Subcostal transversus abdominis plane block for postoperative analgesia in liver transplant recipients: a before-and-after study
  1. Mona Assefi1,
  2. Emma Trillaud1,
  3. Corinne Vezinet1,
  4. Baptiste Duceau1,
  5. Elodie Baron1,
  6. Stephanie Pons1,
  7. Noemie Clavieras1,
  8. Cyril Quemeneur1,
  9. Agathe Selves1,
  10. Olivier Scatton2,
  11. Antoine Monsel1,3 and
  12. Jean-Michel Constantin1
  1. 1GRC 29, AP-HP, DMU DREAM and Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
  2. 2AP-HP, Department of Hepatobiliary and Liver Transplantation Surgery, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
  3. 3INSERM UMRS_959, Immunology-Immunopathology-Immunotherapy (I3), Sorbonne University, Paris, France
  1. Correspondence to Dr Mona Assefi, GRC 29, AP-HP, DMU DREAM and Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France; mona.assefi{at}aphp.fr

Abstract

Introduction Postoperative pain management after orthotopic liver transplantation is complex due to impaired liver function and frequent acute kidney dysfunction. Subcostal transversus abdominis plane (TAP) block may be of interest in this population. The aim of this study was to evaluate the impact of subcostal TAP block on opioid consumption after liver transplantation.

Methods We conducted a before-and-after single center study. During the first period, we included patients whom did not receive an analgesic TAP block. During the second period, we included those with bilateral ultrasound-guided subcostal TAP block (20 mL ropivacaïne 0.2% each side). Patients requiring sedation within 48 hours of surgery as well as patients with combined liver and kidney transplants or skin-only closures were excluded. The primary outcome was cumulative oral morphine consumption within 48 hours after surgery. Secondary outcomes included pain scores and TAP block-related complications.

Results A total of 132 patients were included in the non-TAP block group and 78 patients in the TAP block group. The median oral morphine equivalent consumption (IQR) within 48 hours following surgery was 74 mg (39; 112) for the non-TAP block group and 50 mg (20; 80) for the TAP block group (p<0.001). There was no difference in pain scores between the two groups. No complications related to the TAP block were reported.

Conclusion Subcostal TAP block appears to have a small opioid reducing effect after orthotopic liver transplantation surgery.

  • Nerve Block
  • Pain, Postoperative
  • Pain Management
  • Critical Care
  • analgesia

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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Footnotes

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  • Contributors MA, ET and J-MC designed the study. AM and OS critically reviewed the study proposal. MA, CV, EB, SP, NC, CQ, AS, OS, AM and J-MC provided and cared for study patients. MA, ET, CV, EB, SP, NC, CQ and AS collected data. MA and BD analyzed the data. MA and J-MC wrote the paper. MA, ET, CV, BD, EB, SP, NC, CQ, AS, OS, AM and J-MC revised the paper. All authors approved the final version of the manuscript. MA is the guarantor of this work and assumes full responsibility for the finished work and the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.