Laparoscopic-assisted transversus abdominis plane block versus port-site infiltration in appendicectomy: multicentre randomized clinical trial.

Abstract

Transversus abdominis plane (TAP) block has been shown to be an effective technique in providing postoperative analgesia across a range of intra-abdominal surgeries. Laparoscopic-assisted transversus abdominis plane (LTAP) block is a recent advancement of this technique. The aim of this trial was to evaluate the effectiveness of LTAP block compared with port-site infiltration (PSI) of local anaesthetic in patients undergoing laparoscopic appendicectomy. A single-blinded RCT was performed across three academic hospitals. Patients were randomized 1 : 1 to receive LTAP block or PSI. The primary outcome was postoperative pain, assessed using a visual analogue scale (VAS). Secondary outcomes were postoperative opioid requirements, length of hospital stay (LOS), time to mobilization, and quality of life (QoL) after hospital discharge. In total, 85 of 87 patients (97.7%) in the LTAP group and 82 of 84 patients (97.6%) in the control (PSI) group were eligible for analysis. The VAS pain scores were statistically significantly lower overall in the LTAP group compared with the control (PSI) group on time-weighted analysis after laparoscopic appendicectomy (-1.7 (95% c.i. -2.06 to -1.34); P < 0.001). The difference-in-difference analysis showed that the mean VAS score for the LTAP group statistically significantly improved at 6 h (-1.63 (95% c.i. -2.55 to -0.70); P = 0.001) and 12 h (-2.06 (95% c.i. -2.92 to -1.20); P < 0.001) with no difference at 24 h (-0.68 (95% c.i. -1.55 to 0.19); P = 0.125). This is in comparison with the PSI group at 6 h (3.72 (95% c.i. 3.27 to 4.17); P < 0.001), 12 h (3.37 (95% c.i. 2.89 to 3.87); P  < 0.011), and 24 h (1.57 (95% c.i. 1.13 to 2.01); P < 0.001). There was a significant reduction in oxycodone requirements in the LTAP group (1.2 versus 0.8; P = 0.032). LTAP block significantly improved early postoperative analgesia outcomes in patients undergoing laparoscopic appendicectomy and holds promise as part of an effective postoperative analgesic regimen. NCT05427266 (http://www.clinicaltrials.gov).