Comparison of methods of providing analgesia after pancreas transplant: IV opioid analgesia versus transversus abdominis plane block with liposomal bupivacaine or continuous catheter infusion

Yar L. Yeap, Jonathan A. Fridell, Derrick Wu, Richard Mangus, Elizabeth Kroepfl, John Wolfe, John A. Powelson

Research output: Contribution to journalArticle

Abstract

Background: Current practices emphasize a multimodal approach to perioperative analgesia due to higher efficacy and decreased opioid usage. Analgesia for pancreas transplant (PT) has traditionally been managed with intravenous (IV) opioids, and reports of transversus abdominis plane (TAP) blocks are limited in this population. Methods: Three interventions were compared in adult PT patients, including IV opioids, TAP catheter, and TAP block with liposomal bupivacaine. Time to return of intestinal function and oral diet, postoperative pain scores, opioid usage, and length of stay were recorded. Results: Study included 197 PT patients: 62 (32%) standard care, 90 (45%) TAP catheters with continuous 0.2% ropivacaine, and 45 (23%) single liposomal bupivacaine TAP block. Pain scores were lowest for the IV opioid group (P < 0.001). The liposomal bupivacaine group had lower pain scores on postoperative days (POD) 1-5 than the TAP catheter group. Opioid use during POD 1-5 was lower for both TAP block groups (P = 0.03). Time to bowel function was faster for the TAP block groups (P < 0.05). Conclusions: Compared with IV opioid analgesia, TAP block interventions were associated with lower overall use of opioids and a faster time to intestinal function following pancreas transplant.

Original languageEnglish (US)
Article numbere13581
JournalClinical Transplantation
DOIs
StatePublished - Jan 1 2019

Fingerprint

Abdominal Muscles
Bupivacaine
Analgesia
Opioid Analgesics
Pancreas
Catheters
Transplants
Pain
Postoperative Pain
Length of Stay
Diet

Keywords

  • multimodal
  • postoperative
  • regional analgesia
  • ropivacaine
  • TAP block

ASJC Scopus subject areas

  • Transplantation

Cite this

Comparison of methods of providing analgesia after pancreas transplant : IV opioid analgesia versus transversus abdominis plane block with liposomal bupivacaine or continuous catheter infusion. / Yeap, Yar L.; Fridell, Jonathan A.; Wu, Derrick; Mangus, Richard; Kroepfl, Elizabeth; Wolfe, John; Powelson, John A.

In: Clinical Transplantation, 01.01.2019.

Research output: Contribution to journalArticle

@article{f8147a9ee8584c859308f3f27cd2c67d,
title = "Comparison of methods of providing analgesia after pancreas transplant: IV opioid analgesia versus transversus abdominis plane block with liposomal bupivacaine or continuous catheter infusion",
abstract = "Background: Current practices emphasize a multimodal approach to perioperative analgesia due to higher efficacy and decreased opioid usage. Analgesia for pancreas transplant (PT) has traditionally been managed with intravenous (IV) opioids, and reports of transversus abdominis plane (TAP) blocks are limited in this population. Methods: Three interventions were compared in adult PT patients, including IV opioids, TAP catheter, and TAP block with liposomal bupivacaine. Time to return of intestinal function and oral diet, postoperative pain scores, opioid usage, and length of stay were recorded. Results: Study included 197 PT patients: 62 (32{\%}) standard care, 90 (45{\%}) TAP catheters with continuous 0.2{\%} ropivacaine, and 45 (23{\%}) single liposomal bupivacaine TAP block. Pain scores were lowest for the IV opioid group (P < 0.001). The liposomal bupivacaine group had lower pain scores on postoperative days (POD) 1-5 than the TAP catheter group. Opioid use during POD 1-5 was lower for both TAP block groups (P = 0.03). Time to bowel function was faster for the TAP block groups (P < 0.05). Conclusions: Compared with IV opioid analgesia, TAP block interventions were associated with lower overall use of opioids and a faster time to intestinal function following pancreas transplant.",
keywords = "multimodal, postoperative, regional analgesia, ropivacaine, TAP block",
author = "Yeap, {Yar L.} and Fridell, {Jonathan A.} and Derrick Wu and Richard Mangus and Elizabeth Kroepfl and John Wolfe and Powelson, {John A.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1111/ctr.13581",
language = "English (US)",
journal = "Clinical Transplantation",
issn = "0902-0063",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Comparison of methods of providing analgesia after pancreas transplant

T2 - IV opioid analgesia versus transversus abdominis plane block with liposomal bupivacaine or continuous catheter infusion

AU - Yeap, Yar L.

AU - Fridell, Jonathan A.

AU - Wu, Derrick

AU - Mangus, Richard

AU - Kroepfl, Elizabeth

AU - Wolfe, John

AU - Powelson, John A.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Current practices emphasize a multimodal approach to perioperative analgesia due to higher efficacy and decreased opioid usage. Analgesia for pancreas transplant (PT) has traditionally been managed with intravenous (IV) opioids, and reports of transversus abdominis plane (TAP) blocks are limited in this population. Methods: Three interventions were compared in adult PT patients, including IV opioids, TAP catheter, and TAP block with liposomal bupivacaine. Time to return of intestinal function and oral diet, postoperative pain scores, opioid usage, and length of stay were recorded. Results: Study included 197 PT patients: 62 (32%) standard care, 90 (45%) TAP catheters with continuous 0.2% ropivacaine, and 45 (23%) single liposomal bupivacaine TAP block. Pain scores were lowest for the IV opioid group (P < 0.001). The liposomal bupivacaine group had lower pain scores on postoperative days (POD) 1-5 than the TAP catheter group. Opioid use during POD 1-5 was lower for both TAP block groups (P = 0.03). Time to bowel function was faster for the TAP block groups (P < 0.05). Conclusions: Compared with IV opioid analgesia, TAP block interventions were associated with lower overall use of opioids and a faster time to intestinal function following pancreas transplant.

AB - Background: Current practices emphasize a multimodal approach to perioperative analgesia due to higher efficacy and decreased opioid usage. Analgesia for pancreas transplant (PT) has traditionally been managed with intravenous (IV) opioids, and reports of transversus abdominis plane (TAP) blocks are limited in this population. Methods: Three interventions were compared in adult PT patients, including IV opioids, TAP catheter, and TAP block with liposomal bupivacaine. Time to return of intestinal function and oral diet, postoperative pain scores, opioid usage, and length of stay were recorded. Results: Study included 197 PT patients: 62 (32%) standard care, 90 (45%) TAP catheters with continuous 0.2% ropivacaine, and 45 (23%) single liposomal bupivacaine TAP block. Pain scores were lowest for the IV opioid group (P < 0.001). The liposomal bupivacaine group had lower pain scores on postoperative days (POD) 1-5 than the TAP catheter group. Opioid use during POD 1-5 was lower for both TAP block groups (P = 0.03). Time to bowel function was faster for the TAP block groups (P < 0.05). Conclusions: Compared with IV opioid analgesia, TAP block interventions were associated with lower overall use of opioids and a faster time to intestinal function following pancreas transplant.

KW - multimodal

KW - postoperative

KW - regional analgesia

KW - ropivacaine

KW - TAP block

UR - http://www.scopus.com/inward/record.url?scp=85066862494&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85066862494&partnerID=8YFLogxK

U2 - 10.1111/ctr.13581

DO - 10.1111/ctr.13581

M3 - Article

C2 - 31038772

AN - SCOPUS:85066862494

JO - Clinical Transplantation

JF - Clinical Transplantation

SN - 0902-0063

M1 - e13581

ER -