A randomised controlled trial to study the analgesic efficacy of transversus abdominis plane block for adult undergoing elective laparoscopic appendectomy

Abstract

Background: Laparoscopic appendectomy has evolved over the years as a minimally invasive approach for appendicitis. Routinely opioids are used for pain control postoperatively, however, its widespread use has numerous side effects and delays postoperative recovery. More recent studies have shown that transversus abdominis plane block reduces postoperative pain and analgesic drug usage. This study aims to evaluate the impact of transversus abdominis plane block in managing postoperative pain following elective laparoscopic appendectomy. Methods: A prospective, randomized, double-blind trial was performed on patients undergoing elective laparoscopic appendectomy. Patients were randomized to receive a TAP block with 0.25% bupivacaine and a control group receiving a TAP block with normal saline infusion. Laparoscopic port sites were infiltrated with bupivacaine in the control group and normal saline in the TAP block intervention group before starting the surgery. Postoperative pain scores were recorded using the visual analog scale scores at dedicated time points. Results: A total of 20 patients were included in the control group and 19 in the TAP block group. Visual analog scale scores were significantly reduced in the TAP block group at 6 hours, 12 hours, and 18 hours (p<0.001 in each). However, there was no significant reduction in the visual analog scale score at 24 hours (p=0.015). There was no significant difference between postoperative nausea (p=0.18), and length of postoperative hospital stay (p=0.93) between the two groups. Consumption of rescue analgesics and antiemetics in the first 24 hours postoperatively between both groups was statistically significant (p=0.005). Conclusions: Bilateral TAP block is safe and effective in reducing the need for analgesics and antiemetics in patients undergoing laparoscopic appendectomy in the postoperative period. In addition, there is a significant improvement in visual analog scale scores in patients after TAP block.