Reducing Opioid Consumption in Postoperative Renal Transplant Patients: A Retrospective Analysis
Indian Journal of Transplantation
Background: Opioid use is high in renal transplant patients, both before and after surgery, in part due to the chronic pain associated with end-stage renal disease. Recent studies have shown patients with high opioid consumption post-transplant have higher incidences of graft loss and mortality. Despite this, opioids remain the mainstay of postoperative analgesia. Aims and Objectives: We wanted to see if known analgesic adjuncts, namely regional anesthesia via a continuous transversus abdominis plane (TAP) catheter block or systemic intravenous lidocaine, could reduce the postoperative opioid requirement in this patient group. Materials and Methods: We conducted a retrospective analysis of renal transplant patients over a 2-year period, comparing patients who had an opioid patient-controlled analgesia pump as their main treatment modality, against patients who had either a TAP block or systemic lidocaine as an adjunct. As a primary outcome measure, we calculated their oral morphine equivalents for the 72 hours post-transplant. We excluded patients who had surgical complications, or were on chronic opioid therapy for other conditions. Results: We identified 86 patients over this study period. We found that regional anesthesia was associated with a 34.4% reduction (P < 0.01) and systemic lidocaine with a 36.5% reduction (P = 0.134) in cumulative opioid consumption without adversely affecting the quality of pain control. No significant complications were noted. Conclusion: Both regional anesthesia and systemic lidocaine are viable opioid sparing adjuncts for postoperative acute pain in this patient population.
Sherman, M., Ho, G., Chu, E., Gumbert, S., Lin, C., Amdur, R., Podolnic, J., Slocum, J., & Heinz, E. (2020). Reducing Opioid Consumption in Postoperative Renal Transplant Patients: A Retrospective Analysis. Indian Journal of Transplantation, 14 (3). http://dx.doi.org/10.4103/ijot.ijot_44_20