RESULTS OF TRANSVERSUS ABDOMINIS PLANE BLOCK AS A COMPONENT OF MULTIMODAL ANALGESIA IN LIVING LIVER DONORS

R. Ibadov¹, S. Ibragimov², S. Ergashev² | ¹Intensive Care Unit, Republican Specialized Scientific and Practical Medical Center of Surgery named after academician V.Vakhidov, Tashkent, Uzbekistan; ²Republican Specialized Scientific and Practical Medical Center of Surgery named after academician V.Vakhidov, Tashkent, Uzbekistan

Abstract

Background and Aims. Postoperative pain in living liver donors contributes to surgical stress, opioid use, and delayed recovery. The aim of the study was to assess the effectiveness of transversus abdominis plane (TAP) block within multimodal analgesia in living liver donors.
Methods. In a prospective study of 80 donors (age 34.7±6.2 years; BMI 24.6±2.8 kg/m²), 40 received bilateral ultrasound-guided TAP-block with 0.25% bupivacaine (50 mL total) plus dexketoprofen and paracetamol, while 40 received systemic analgesia (NSAIDs + opioids as needed). The groups were comparable in age, sex, BMI, duration of surgery (312±48 vs. 318±51 min), and intraoperative blood loss (420±110 vs. 445±120 mL) (p>0.05). Pain intensity was assessed using the VAS at 2, 6, 12, 24, and 48 hours postoperatively. Pain (VAS), opioid consumption, hemodynamics, metabolic parameters, recovery profile, ICU stay, and PONV were evaluated.
Results. The TAP block significantly reduced pain scores at 6, 24, and 48 hours (all p<0.001) and decreased opioid consumption by more than threefold (6.4±3.1 mg vs 18.7±5.6 mg; p<0.001), with opioids required in 27.5% of patients compared to 82.5% (p<0.001). Donors with TAP block showed lower heart rate and blood glucose; earlier mobilization (18.3±4.2 vs 27.6±5.1 h; p<0.001); faster bowel recovery (22.5±6.4 vs 32.8±7.2 h; p<0.001); shorter ICU stay (2.1±0.6 vs 3.4±0.9 days; p<0.001); and lower PONV incidence (15% vs 42.5%; p=0.01). Lactate, transaminases, bilirubin, and INR were significantly lower, indicating reduced metabolic stress and better early liver function. No TAP-related complications occurred.
Conclusions. TAP block in living liver donors significantly reduces postoperative pain and opioid use, attenuates the stress response, and accelerates recovery.