Comparison of continuous intravenous lidocaine versus transversus abdominis plane block for kidney transplant surgery: a randomized, non-inferiority trial. Issue 11 (20th August 2021)

• Record Type: Journal Article
• Authors: Hanson, Neil A; Strunk, Joseph; Saunders, Genna; Cowan, Nick G; Brandenberger, Jared; Kuhr, Christian S; Oryhan, Christine; Warren, Daniel T; Slee, April E; Strodtbeck, Wyndam
• Is Part Of: Regional anesthesia and pain medicine. Volume 46:Issue 11(2021)
• Page Start: 955
• Page End: 959
• Publication Date: 2021-08-20
• Subjects: analgesia -- drug-related side effects and adverse reactions -- nerve block -- pain -- postoperative -- ultrasonography; Conduction anesthesia -- Periodicals; Pain medicine -- Periodicals; 617.964
• DOI: 10.1136/rapm-2021-102973
• Languages: English
• ISSNs: 1098-7339

Abstract

Abstract : Background and objectives: Transversus abdominis plane (TAP) blocks are associated with an improvement in postoperative analgesia following kidney transplant surgery. However, these blocks carry inherent risk and require a degree of expertise to perform successfully. Continuous intravenous lidocaine may be an effective alternative. In this randomized, non-inferiority study, we hypothesized that a continuous lidocaine infusion provides similar postoperative analgesia to a TAP block. Methods: Subjects presenting for kidney transplant surgery were randomized in a 1:1 ratio to either an ultrasound-guided unilateral, single-injection TAP block (TAP group) or a continuous infusion of lidocaine (Lido group). The primary outcome of this non-inferiority study was opioid consumption within the first 24 hours following surgery. Secondary outcomes included pain scores, patient satisfaction, opioid-related adverse events, time to regular diet, and persistent opioid use. Results: One hundred and twenty subjects, 59 from the TAP group and 61 from the Lido group, completed the study per protocol. Analysis of the primary outcome showed a cumulative geometric mean intravenous morphine equivalent difference between the TAP (14.6±3.2 mg) and Lido (15.9±2.4 mg) groups of 1.27 mg (95% CI −4.25 to 6.79; p<0.001), demonstrating non-inferiority of the continuous lidocaine infusion. No secondary outcomes showed clinically meaningful differences between groups. Conclusions: This study demonstrates that a continuous infusion of lidocaine offers non-inferior postoperative analgesia compared with an ultrasound-guided unilateral, single-injection TAP block in the first 24 hours following kidney transplant surgery. Trial registration number: NCT03843879 .