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A RETROSPECTIVE AGE-MATCHED COMPARISON ASSESSING THE VALUE OF
TRANSVERSUS ABDOMINIS PLANE (TAP) CATHETERS IN REDUCING
POSTOPERATIVE OPIOID REQUIREMENTS IN CHILDREN UNDERGOING RENAL
TRANSPLANTATION
Frank PENNA, Hissan BUTT, Rakan ODEH, Elizabeth HARVEY, Walid FARHAT, Martin KOYLE, Darius BÄGLI, Jason HAYES
and Armando LORENZO
The Hospital for Sick Children, Toronto, CANADA
INTRODUCTION
After renal transplantation (RT), children often exhibit large opioid requirements, with known side effects and
complications. To address this problem, we have introduced transversus abdominis plane (TAP) catheters with
continuous postoperative local anesthetic (bupicavaine) infusion, placed under direct vision at the time of RT. Herein,
we present a preliminary effectiveness and safety assessment of this novel approach as part of a multi-modal pain
management strategy.
PATIENTS AND METHODS
Twenty children who underwent RT with intra-operatively placed TAP catheters at our center over a two-year period
(2012-2014) were age-matched to twenty patients managed only with systemic analgesics. The technique involved
ipsilateral deployment of two 3-hole epidural catheters between the internal oblique and transversus abdominis muscles,
at two different locations along the Gibson incision, following the direction of the nerves. Postoperative opioid utilization
was compared between these two groups over the early postoperative period. Opioid use was standardized by
conversion to intravenous morphine equivalents (mg/kg).
RESULTS
The TAP catheter arm demonstrated a trend towards lower postoperative opioid use as compared to the control arm,
with the postoperative day (POD) 1-2 time period approaching statistical significance (see table). There were no
adverse events.
TAP catheter arm (20) Control arm (20)
p
Weight (kg)
36.9±18.1
31.4±23.5
0.20
Age (yr)
12.8±4.9
12.0±5.6
0.34
Postop opioid (mg/kg)
POD 0-1
0.45±0.44
0.57±0.57
0.31
POD 1-2
0.33±0.29
0.62±0.48
0.06
POD 2-3
0.30±0.33
0.31±0.21
0.47
Total
1.08±0.88
1.50±0.86
0.15
CONCLUSIONS
Our preliminary data suggest that the novel use of dual ipsilateral TAP catheters with local anesthetic infusion lowers
mean opioid utilization after pediatric RT when compared to age-matched controls. Additional patient recruitment is
necessary to provide a large sample size for statistically meaningful comparison.