Abstract
BACKGROUND: Epidural analgesia can improve early postoperative recovery after renal transplantation. Abdominal wall blocks (transversus abdominis plane (TAP) and rectus sheath (RS)) combined with patient-controlled intravenous analgesia (PCIA) have also been shown to enhance postoperative recovery. However, it remains unclear whether these techniques are as effective as epidural analgesia (EP). METHODS: In this single-centre randomized non-inferiority clinical trial, participants undergoing renal transplantation were randomly assigned to receive either a TAP + RS block (combined with PCIA) or EP alone. The primary outcome was Quality of Recovery-15 (QoR-15) scores on postoperative day (POD) 1. Secondary outcomes included haemodynamics, indices of postoperative renal function, time to interventions, and postoperative pain scores. RESULTS: Ninety participants were included in the analysis. The TAP + RS group demonstrated non-inferiority to the EP group in terms of the mean(standard deviation) total QoR-15 score on POD1 (90.6(5.0) versus 92.4(6.4); mean difference, -1.8; 95% confidence interval -4.2 to 0.6; P < 0.001 for non-inferiority). QoR-15 scores on POD3 and POD7 and indices of postoperative renal function were comparable between the two groups, with no group-time interactions. The EP group had significantly lower mean arterial pressure and intraoperative opioid consumption, as well as shorter times to eye opening and extubation, than the TAP + RS group. However, the intervention time was longer in the EP group (P < 0.001). CONCLUSION: TAP + RS block combined with PCIA demonstrated non-inferiority to EP for postoperative QoR-15 scores after kidney transplantation. TAP + RS block offers a potentially more convenient and favourable alternative to EP, helping maintain haemodynamic stability, postoperative renal function, and a low complication profile. REGISTRATION NUMBER: ChiCTR2200056455 (https://www.chictr.org.cn).