ESPN 50th Annual Meeting

ESPN 2017


 
Improving post-operative outcomes in paediatric renal transplant recipients using a continuous transversus abdominis plane block infusion
CAMILLA MASSARDI 1 KEN KAWAMOTO 1 CHRISTOPHER HOLMES 1 MATTHEW JAY 1 NICOS KESSARIS 2 HELEN HUME-SMITH 1 STEPHEN MARKS 1

1- GREAT ORMOND STREET HOSPITAL FOR CHILDREN NHS FOUNDATION TRUST
2- GUYS HOSPITAL
 
Introduction:

Managing post-operative pain is fundamental for paediatric renal transplant recipients (pRTR).  Opioid elimination is impaired in renal dysfunction, resulting in reduced clearance and opioid-related side effects. A transversus abdominis plane block (TAPB) uses local anaesthetic to interrupt sensory innervation from the surgical site. A catheter-mediated continuous TAPB infusion has seen improvements in postoperative morphine consumption and pain scores in adult renal transplant recipients, but has not yet been reported in pRTR. 

Material and methods:

Single center case-series of 27 pRTR of median age 12.0 years (Group 1) who received perioperative bolus TAPB and 3 pRTR of median age 16.6 years (Group 2) who received TAPB with continuous infusion of 0.125% levobupivacaine post-renal transplantation.

Inclusion criteria: uncomplicated pRTR of dry weight >20kg receiving a living donor-related renal graft onto iliac vessels. 

Outcomes were assessed for each Group 2 individual and an auditing cycle applied to implement changes for subsequent patients.

Results:

Median post-operative morphine consumption reduced from 22.0 (0.0– 63.5) to 5.8 (0.3 – 50.8) mcg/kg/hour in Groups 1 and 2 respectively.

Proportion of pain scores ≥4 within two days post-transplant (%) decreased from a median of 4.6 (0.0 - 60.0) to 0.5 (0 - 29.2).

Increase in median time to discharge (days) from 10 (6-25) to 13 (9-13) and time to first fluids (hours) from 19.0 (9.0 - 39.5) to 50.0 (24.0-53.0).

Group 2 showed decreased prevalence of nausea/vomiting but increased prevalence of pruritus. Neither group experienced respiratory depression.

There were no complications from the placement of the TAP block catheters intra-operatively.

Conclusions:

This is the first study that demonstrates reduced postoperative morphine consumption in pRTR who have received TAPB with continuous infusion. Outcomes for these patients varied within the group, representing a learning curve for catheter placement. 

Further randomised controlled studies are required to study the benefits in a larger cohort of pRTR.