Subcostal Transversus Abdominis Plane Block for Postoperative Analgesia in Liver Transplant Recipients

Background. Postoperative pain treatment in orthotopic liver transplant (OLT) patients is a challenge. We performed a pilot study on ultrasound-guided transversus abdominis plane (TAP) block in OLT patients. To test the efficacy of this technique, which is novel to OLT patients, we compared morphine consumption, pain scores, and time to extubation with a matching control group. Methods. Seventeen patients who underwent OLT underwent bilateral ultrasound-guided TAP block using a subcostal approach with levobupivacaine (0.5%; 20 mL each) followed by postoperative morphine patient-controlled analgesia (PCA). The control group of 17 patients had only morphine PCA. We recorded the total morphine consumption, postoperative pain, and time to extubation. Results. The total amount of morphine consumption over 24 hours was 45.9 +/- 33.9 mg in the TAP group and 71.8 +/- 39.9 mg in the control group (P < .005). Median pain scores were 1 in the TAP group and 2 in the control group (not significant [NS]). Median time to extubation was 60 minutes in the TAP group and 97 minutes in the control group (P = NS). Conclusion. Initial evaluation of subcostal TAP block after OLT showed significant reduction in postoperative morphine consumption.