Effect of Regional Anesthesia on Recovery Outcomes After Pediatric Renal Transplantation: A Retrospective Study

The quadratus lumborum (QL) and transversus abdominis plane (TAP) blocks reduce opioid consumption and pain scores in adult renal transplantation. However, their efficacy in pediatric renal transplantation remains unknown. This retrospective study investigates the effect of different regional anesthesia techniques on postoperative opioid consumption and recovery outcomes following pediatric renal transplantation.

Retrospective review of pediatric patients undergoing renal transplantation at a single academic children's hospital between January 2019 and September 2023. Patients received either an anterior QL block with contralateral RS block (QL/RS group), high-dose TAP block (hTAP group), low-dose TAP block (lTAP group), or no block (control group). The primary aim was to compare postoperative opioid consumption. The secondary outcomes were intraoperative opioid consumption, median operative time, time to extubation, and length of stay (LOS) in the intensive care unit (ICU) and hospital.

There was no difference in opioid consumption in milligram morphine equivalents per kilogram (MME/kg) on postoperative days (POD) 0 and 1 between each block group as compared to the no block group. The QL/RS group had the shortest time to extubation, with all patients extubated in the operating room (compared to 5.2 ± 21.2 h in the hTAP group, 2.4 ± 7.8 h in the lTAP group, and 10.9 ± 22.6 h in the no block group). There was no difference in ICU LOS. The QL/RS, hTAP, lTAP groups all had shorter overall hospital LOS (median days [95% CI]: 6.3 [5.6, 6.6], p = 0.01; 6.4 [5.6, 7.2], p = 0.02; 5.6 [4.4, 6.9], p = 0.01; respectively) as compared to the no block group (7.3 [6.6, 8.5] days).

Although there was no significant difference in postoperative opioid consumption between groups, the QL/RS block group was associated with the shortest time to extubation, with all patients extubated in the operating room. All block groups had reduced overall hospital LOS compared to the no block group. Both QL/RS and TAP blocks may offer benefits in perioperative recovery, warranting further prospective investigation to optimize regional anesthesia strategies for pediatric renal transplant recipients.