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- Title
Evaluation of transversus abdominis plane block for renal transplant recipients – A meta‑analysis and trial sequential analysis of published studies.
- Authors
SINGH, PREET MOHINDER; BORLE, ANURADHA; TRISHA, AANJAN; MAKKAR, JEETINDER KAUR; SINHA, AASHISH
- Abstract
Background: Patients undergoing renal transplant (RT) have altered drug/opioid pharmacokinetics. Transversus abdominis plane (TAP) block in renal transplant recipients has been recently evaluated for analgesic and opioid‑sparing potential by many trials. Methodology: The studies comparing TAP‑block to conventional analgesic regimens for RT were searched. Comparisons were made for total opioids consumed (as morphine‑equivalents) during the first postoperative 24‑h (primary objective), intraoperative, and immediate‑postoperative period. Pain scores and postoperative nausea‑vomiting (PONV) were also evaluated. Trial sequential analysis (TSA) was used to quantify the strength of analysis. Results: Ten‑trials with 258 and 237 patients in control and TAP‑block group, respectively, were included. TAP‑block decreased the 24‑h (reported in 9‑trials) opioid consumption by 14.61 ± 4.34 mg (reduction by 42.7%, random‑effects, P < 0.001, I2 = 97.82%). Sample size of the present analysis (472) was well past the required “information‑size” variable (396) as per the TSA for a power of 85%. Intraoperative opioid consumption also decreased by 2.06 ± 0.63 mg (reduction of 27.8%) (random effects, P < 0.001, I2 = 98.84%). Pain scores with TAP‑block were significantly lower in both early and delayed postoperative phase. Odds ratio for PONV without TAP block was 1.99 ± 1.05 (Fixed‑effects, P = 0.04, I2 = 0%). Publication bias was likely (Egger’s test, X‑intercept=7.89, P < 0.05). Conclusions: TAP‑block significantly lowers the intraoperative and cumulative postoperative 24‑h opioid consumption in RT recipients. Persistent and better pain control is achieved when TAP‑Block is used. Benefits of TAP block extend beyond the analgesic actions alone as it also decreases the 24‑h incidence of postoperative nausea vomiting as well. The technique of the block needs standardization for RT recipients.
- Subjects
KIDNEY transplantation; TRANSPLANTATION of organs, tissues, etc.; TRANSVERSUS abdominis muscle; OPIOID analgesics; ORGANS (Anatomy); SURGERY
- Publication
Saudi Journal of Anaesthesia, 2018, Vol 12, Issue 2, p261
- ISSN
1658-354X
- Publication type
Article
- DOI
10.4103/sja.SJA_598_17