Abstract / Summary
Introduction: Laparoscopic donor nephrectomy is a minimally invasive procedure, with postoperative pain being a major concern, increasing opioid use. The use of opioids is limited due to their adverse effects, and Non-Steroidal Anti-inflammatory Drugs (NSAIDs) are avoided due to their nephrotoxic effects. Aim: To compare the pain control efficacy and opioid-reducing effect of Transversus Abdominis Plane (TAP) block using 0.5% Ropivacaine and port site local infiltration of 0.5% Ropivacaine in patients undergoing laparoscopic donor nephrectomy Materials and Methods: This randomised double-blinded controlled study was conducted among 72 patients who underwent laparoscopic nephrectomy in Department of Anaesthesiology at Kovai Medical Centre and Hospital (KMCH), Tamil Nadu, India, from January 2023 to January 2024. Patients were randomised equally into two groups, 36 each. Group 1 was given port site local infiltration of 0.5% Ropivacaine, and Group 2 received 0.5% Ropivacaine via TAP block. The dose of Ropivacaine varied according to the weight of the patients. All the patients were evaluated a day before surgery, preoperatively. Postoperative pain scores, haemodynamic parameters, and rescue analgesic requirement were assessed. Mean Visual Analogue Scale (VAS) score was compared between the two groups using the Mann-Whitney U test, and the Rescue analgesic requirement was assessed using the Chi-square test. A p-value <0.05 was considered statistically significant. Results: Among the 72 patients who underwent laparoscopic nephrectomy, more than half of the patients were aged 21-50 years with the majority being Females in both groups. The mean postoperative VAS score at extubation was significantly lower in Group 2 than in Group 1 (1.5±0.7 vs. 2.1±0.7; p=0.001). At one hour post-extubation, the mean VAS score was significantly lower in Group 2 than in Group 1 (1.4±1.4 vs. 2.3±1.4; p=0.006). Furthermore, total rescue opioid administration was significantly lower in the TAP block group 14 (38.9%) compared to the port-site group 26 (72.2%), which was significant with a p-value of 0.03. Conclusion: The ultrasound-guided TAP block provides early postoperative analgesia and achieves a highly significant reduction in systemic opioid consumption compared to port-site infiltration. These findings indicate that the TAP block serves as a highly effective, safe regional alternative.