Ultrasound-Guided Transversus Abdominis Plane Blocks for Mini-Laparotomy in Allogeneic Islet Cell Transplantation: a Case Report and Retrospective Series

Background: Islet allotransplantation (ITA) is a surgical approach for treating patients with type 1 diabetes mellitus (T1DM) and severe hypoglycemic unawareness. Surgeons at the University of Minnesota typically perform ITA via mini-laparotomy (MLAP) under monitored anesthesia care (MAC) unless generalized endotracheal anesthesia (GETA) is indicated or needed. Herein, we studied the use of ultrasound-guided transversus abdominis plane (TAP) blocks to optimize perioperative analgesia. Methods: We report the case of a 46-year-old man with a 24-year history of T1DM and recurrent hypoglycemic seizures who underwent two ITA procedures via MLAP with preoperative TAP blocks. To provide more information about the broader impact of TAP blocks, we analyzed the outcomes of 51 MLAP-based ITA procedures. Results: In our case report patient, both procedures were completed without complications. The patient reported minimal postoperative pain, ambulated within 24 h, and was discharged on postoperative days 3 and 2, respectively. The patient remained free from severe hypoglycemia for 10 years, and he only began to require minimal doses of long-acting insulin in the past year. From additional case review, TAP blocks were used in 22% of the cases. The use of TAP blocks did not lead to significant differences in operative duration or length of stay. Conclusions: Although TAP blocks can be used as part of an enhanced recovery after surgery (ERAS) approach, we did not identify any significant advantages of using TAP blocks over field blocks during MLAP-based ITA procedures among patients with T1DM.