Laparoscopic-assisted transversus abdominis plane block versus port-site infiltration in appendicectomy: multicentre randomized clinical trial
Year: 2025
Type: article
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSION: LTAP block significantly improved early postoperative analgesia outcomes in patients undergoing laparoscopic appendicectomy and holds promise as part of an effective postoperative analgesic regimen. REGISTRATION NUMBER: NCT05427266 (http://www.clinicaltrials.gov).
Source: British journal of surgery
DOI: 10.1093/bjs/znaf257
Authors: Gordon R Daly, Gavin P Dowling, Sandra Hembrecht, Sorcha O’Grady, Aisling Hegarty, Trudi Roche, Gabriel Orsi, Arielle Pierre, Gavin G Calpin, Colm Neary, Cian M Hehir, Gerard J Hill, Abigail O'Brien, William P Duggan, Matthew G Davey, Ian J B Stephens, Niall D Kennedy, Oisín Brennan, Cathal Hayes, Mohammed Al Azzawi, Ishwarya Balasubramanian, Andrew McGuire, Alexandra M Zaborowski, Ian S Reynolds, Paula Loughlin, Michael Allen, Colm Power, Abeeda Butt, Michael R Boland, Niamh McCawley, John P Burke, William B Robb, Achille Mastrosimone, Mayilone Arumugasamy, Hugo Prins, David Beddy, Michael J Kerin, Deborah A McNamara, David Kearney, Jan Sorensen, Gerard F Curley, Sami Abd El Wahab, Arnold D K Hill
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $5,007
OpenAlex ID: W7121485093