Comparative effectiveness of TAP block, EOIP block, and standard care for postoperative analgesia in renal transplantation: a retrospective study
Efetividade comparativa do bloqueio TAP, bloqueio EOIP e cuidado padrão para analgesia pós-operatória em transplante renal: um estudo retrospectivo
Karam Azem, Roussana Aranbitski, Safo Awad, Omer Shpack, Alexander Peres, Rotem Argov, Omer Kaplan, Anatoliy Artyukh, Andrey Khinchuk, Michael Yohay Stav, Philip Heesen, Sharon Orbach-Zinger, Eviatar Nesher, Shai Fein
Abstract
Background
Effective pain management following renal transplantation is crucial. While various regional analgesic techniques have been studied, the optimal approach remains unclear. We
compared the additive value of Transversus Abdominis Plane (TAP) and External Oblique Intercostal Plane (EOIP) blocks to Standard Care (SC) on postoperative pain and opioid consumption.
Methods
This retrospective study included 237 renal transplant recipients (127 SC, 75 TAP, 35 EOIP) between January 2023 and December 2024. Multivariable regression analysis assessed the association of block type on postoperative pain and opioid consumption.
Results
TAP block was associated with significantly lower pain scores than SC during the first eight postoperative hours (5.0 vs. 7.0, p < 0.001). Pre-incision TAP block demonstrated the most significant reduction in both pain scores (b = -2.21, 95% CI -3.38 to -1.05, p < 0.001) and opioid consumption (b = -13.56, 95% CI: -21.59 to -5.52, p = 0.001). EOIP block showed no significant advantages over SC and was associated with higher opioid consumption compared to TAP block.
Conclusion
Pain predominantly manifested in the first eight postoperative hours. TAP block, particularly when administered pre-incision, was associated with superior pain control compared
to SC or EOIP block. Living donor recipients experienced significantly higher pain scores regardless of technique, warranting further investigation.
Keywords
Resumo
Introdução
O manejo eficaz da dor após o transplante renal é essencial. Embora diversas técnicas de analgesia regional tenham sido estudadas, a abordagem ideal permanece incerta. Comparamos o valor adicional dos bloqueios do Plano do Músculo Transverso Abdominal (TAP) e do Plano Intercostal do Músculo Oblíquo Externo (EOIP) com o Cuidado Padrão (SC) na dor pós-operatória e no consumo de opioides.
Métodos
Este estudo retrospectivo incluiu 237 receptores de transplante renal (127 SC, 75 TAP, 35 EOIP) entre janeiro de 2023 e dezembro de 2024. A análise de regressão multivariada avaliou a associação entre o tipo de bloqueio e a dor pós-operatória, além do consumo de opioides.
Resultados
O bloqueio TAP foi associado a escores de dor significativamente menores do que SC durante as primeiras oito horas pós-operatórias (5,0 vs. 7,0, p < 0,001). O bloqueio TAP pré-incisão apresentou a maior redução tanto nos escores de dor (β = –2,21, CI 95% –3,38 a –1,05, p < 0,001) quanto no consumo de opioides (β = –13,56, CI 95% –21,59 a –5,52, p = 0,001). O bloqueio EOIP não mostrou vantagens significativas sobre SC e esteve associado a maior consumo de opioides em comparação ao bloqueio TAP.
Conclusion
A dor manifestou-se predominantemente nas primeiras oito horas pós-operatórias. O bloqueio TAP, especialmente quando administrado antes da incisão, foi associado a melhor controle da dor em comparação ao SC ou ao bloqueio EOIP. Receptores de doadores vivos apresentaram escores de dor significativamente mais altos independentemente da técnica, o que exige investigação adicional.
Palavras-chave
Referências
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Submetido em:
10/05/2025
Aceito em:
08/10/2025
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