Effectiveness of Ultrasonographic Unilateral Dual Transversus Abdominis Plane Block in Pain Control in Pediatric Renal Transplantation: A Randomized Controlled Trial

Abstract Background: Effective postoperative pain control in pediatric kidney transplant recipients is essential but poses challenges due to the limitations of systemic opioid use in patients with renal dysfunction. This study evaluated the efficacy and safety of an ultrasound-guided unilateral dual-transversus abdominis plane (D-TAP) block as part of a multimodal analgesia regimen in children undergoing living-donor kidney transplantation. Materials and Methods: In this randomized controlled trial, 44 pediatric patients aged 3–16 years scheduled for renal transplantation were randomized to receive either a D-TAP block plus standard intravenous analgesia (D-TAP group) or intravenous analgesia alone (control group). The primary outcome was total pethidine consumption in the first 24 h postoperatively. Secondary outcomes included time to first rescue analgesia, pain scores using the Objective Behavioral Pain Scale, and hemodynamic parameters. Results: The D-TAP group had significantly lower total pethidine consumption compared to the control group (37.86 ± 27.70 vs 64.05 ± 42.27 mg, P = 0.020). Although not statistically significant, the time to first rescue analgesia was longer in the D-TAP group (3.47 ± 3.59 vs 2.48 ± 4.68 h, P = 0.189), and fewer patients required rescue analgesia (22.7% vs 4.5%). Pain scores were consistently lower in the D-TAP group across the 24-h period. Intraoperative heart rates were significantly reduced at multiple time points in the D-TAP group, without clinically significant differences in blood pressure or central venous pressure. No block-related complications were observed. Conclusion: Ultrasound-guided unilateral dual TAP block is an effective and safe regional anesthesia technique that reduces postoperative opioid requirements and provides stable intraoperative hemodynamics in pediatric renal transplant recipients. It should be considered part of a multimodal analgesia strategy in this high-risk population.