Efficacy of Bilateral Versus Unilateral Transversus Abdominis Plane Blocks in Pain Control After Kidney Transplantation: A Retrospective Review.

Background Postoperative pain management is a critical component of care following major surgical procedures such as kidney transplantation. Inadequate pain control can increase morbidity, while reliance on systemic opioids may lead to adverse effects. The transversus abdominis plane (TAP) block provides regional analgesia to the anterolateral abdominal wall and has been increasingly used as part of multimodal analgesia strategies. Given conflicting evidence regarding unilateral versus bilateral approaches, this study aimed to determine whether bilateral TAP blocks provide superior early postoperative analgesia compared with unilateral TAP blocks in adult kidney transplant recipients. Methods We conducted a retrospective chart review of 83 adult kidney transplant recipients (37 bilateral TAP blocks and 46 unilateral TAP blocks) at a single institution. Postoperative pain scores were assessed using the Numerical Rating Scale (NRS), and opioid consumption was recorded and converted to morphine milligram equivalents (MME). Pain scores and opioid requirements were compared between the bilateral and unilateral TAP block groups. Results Bilateral TAP blocks were associated with significantly lower pain scores during the first 12 hours postoperatively for all patients (p=0.0153) compared with unilateral blocks. However, no significant difference was observed in 24-hour pain scores for the overall cohort (p=0.3917). The reduction in pain scores appeared to be driven primarily by male patients, who demonstrated significantly lower pain scores at both 12 hours (p=0.0021) and 24 hours (p=0.0335) when receiving bilateral TAP blocks. In contrast, no statistically significant differences were observed between the groups among female patients at either 12 hours (p=0.7768) or 24 hours (p=0.3545). Total opioid consumption did not differ significantly between bilateral and unilateral TAP block groups for the overall cohort (p=0.9526), male patients (p=0.7024), or female patients (p=0.7511). Conclusion Bilateral TAP blocks may provide improved early postoperative analgesia following kidney transplantation, particularly during the first postoperative hours. However, this improvement in pain scores was not associated with a reduction in opioid consumption. Further studies are needed to clarify the clinical significance of these findings and to determine whether specific patient populations may benefit more from bilateral TAP block techniques.