Ultrasound-guided subcostal transversus abdominis plane blocks with liposomal bupivacaine vs. non-liposomal bupivacaine for postoperative pain control after laparoscopic hand-assisted donor nephrectomy: a prospective randomised observer-blinded study.
Hutchins JL, Kesha R, et al.Anaesthesia 2016;71(8):930-7
Aims
To compare the effect of subcostal transversus abdominis plane (TAP) blocks using liposomal bupivacaine with TAP blocks using non-liposomal bupivacaine on postoperative maximal pain scores in patients undergoing donor nephrectomy.
Interventions
Participants were randomized to undergo TAP block with either 1.3% liposomal bupivacaine with normal saline, versus non-liposomal 0.25% bupivacaine with adrenaline 1:200,000.
Participants
60 donor nephrectomy patients.
Outcomes
The primary outcome measured was maximal pain score. Other outcomes measured included opioid and ketorolac use, minimum pain scores, nausea and vomiting, and length of stay.
Follow-up
72 hours
CET Conclusions
This RCT compares transversus abdominis plane (TAP) blocks using liposomal bupivacaine versus non-liposomal bupivacaine with adrenaline in patients undergoing donor nephrectomy. The study was partly blinded as staff performing the block were not blinded but patients and outcome assessors were blinded to the intervention. The sample size calculation showed that 30 patients per arm were needed to achieve a power of 80% taking into account loss to follow, conversion to open surgery or change in surgical site, or noncompliance. 59 out of 60 randomised patients were analysed and provided pain scores up to 72 hours postoperatively. The liposomal bupivacaine group had lower median maximum pain scores between 24-72 hrs postoperatively and lower opoid use between 48-72 hrs postoperatively. There was no difference in ketorolac use between groups. Nausea and vomiting were reported less frequently and the median length of hospital stay was significantly shorter for the liposomal bupivacaine group.
Data analysis
Modified intention-to-treat analysis
Trial registration
Clinicaltrials.gov - NCT02287623