Successful Opioid Minimization Following Kidney Transplant: A Quality Improvement Initiative

Area of Science:

• Nephrology
• Transplant Surgery
• Pain Management
• Pharmacology

Background:

• Opioid use post-kidney transplant is linked to increased mortality and graft loss.
• Multimodal analgesia and educational strategies show promise in reducing opioid consumption.
• Standardized protocols are needed to optimize pain management and minimize opioid reliance in transplant recipients.

Purpose of the Study:

• To evaluate the impact of an opioid minimization protocol on inpatient opioid consumption and discharge prescribing practices.
• To assess the effectiveness of a protocol combining ultrasound-guided transversus abdominis plane (TAP) blocks with scheduled non-opioid analgesics.

Main Methods:

• A single-center, retrospective study comparing 59 kidney transplant recipients (post-protocol) with 52 pre-protocol recipients (October 2021-July 2022).
• The protocol involved intra-operative TAP blocks, scheduled acetaminophen and gabapentin, with tramadol as needed.
• Patients on chronic opioids pre-transplant were excluded; doses were adjusted for renal impairment.

Main Results:

• Significant reductions in total inpatient morphine milligram equivalents (MMEs) per day were observed post-protocol.
• No patient-controlled analgesia (PCA) devices were required in the post-protocol group.
• Discharge opioid prescribing decreased significantly; no differences in pain scores, return to OR, readmission, or length of stay were noted.

Conclusions:

• The opioid minimization protocol effectively reduced inpatient opioid use and discharge prescriptions in kidney transplant patients.
• Scheduled acetaminophen and gabapentin, with or without TAP blocks, enabled the elimination of PCA devices.
• This multimodal approach achieved significant opioid reduction without compromising patient-reported pain or key clinical outcomes.