A randomised controlled trial to study the analgesic efficacy of transversus abdominis plane block for adult undergoing elective laparoscopic appendectomy
DOI:
https://doi.org/10.18203/2349-2902.isj20233679Keywords:
Laparoscopy, Appendectomy, Transversus abdominis plane block, Petit triangle, Visual analog scoreAbstract
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.
References
Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery. Lancet Lond Engl. 2003;362:1921-8.
Aida S, Baba H, Yamakura T, Taga K, Fukuda S, Shimoji K. The effectiveness of preemptive analgesia varies according to the type of surgery: a randomized, double-blind study. Anesth Analg. 1999;89:711-6.
Chung F, Ritchie E, Su J. Postoperative pain in ambulatory surgery. Anesth Analg. 1997;85:808-16.
White PF. The role of non-opioid analgesic techniques in the management of pain after ambulatory surgery. Anesth Analg. 2002;94:577-85.
Haefeli M, Elfering A. Pain assessment. Eur Spine J. 2006;15(1):S17-24.
Silvasti M, Svartling N, Pitkänen M, Rosenberg PH. Comparison of intravenous patient-controlled analgesia with tramadol versus morphine after microvascular breast reconstruction. Eur J Anaesthesiol. 2000;17:448-55.
Immer FF, Immer-Bansi AS, Trachsel N. Pain treatment with a COX-2 inhibitor after coronary artery bypass operation: a randomized trial. Ann Thorac Surg. 2003;75:490-5.
Petersen PL, Mathiesen O, Torup H, Dahl JB. The transversus abdominis plane block: A valuable option for postoperative analgesia? A topical review. Acta Anaesthesiol Scand. 2010;54:529-35.
Carney J, Finnerty O, Rauf J, Curley G, McDonnell JG, Laffey JG. Ipsilateral transversus abdominis plane block provides effective analgesia after appendectomy in children: A randomized controlled trial. Anesth Analg. 2010;111:998-1003.
McDonnell JG, Curley G, Carney J. The analgesic efficacy of transversus abdominis plane block after cesarean delivery: A randomized controlled trial. Anesth Analg. 2008;106:186-91.
Kessler RC, Angermeyer M, Anthony JC. Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization's World Mental Health Survey Initiative. World Psychiatr. 2007;6:168-76.
Seyedhejazi M, Motarabbesoun S, Eslampoor Y, Taghizadieh N, Hazhir N. Appendectomy Pain Control by Transversus Abdominis Plane (TAP) Block in Children. Anesth Pain Med. 2019;9(1):e839.
Shahmoradi MK, Besharatifar G, Taheri HR. Analgesic effects of TAP block among open appendectomy patients and the need of postoperative pethidine for Pain Management: A randomised controlled trial. Int J Surg. 2020;27:166-71.
Tanggaard K, Jensen K, Lenz K. A randomised controlled trial of bilateral dual transversus abdominis plane blockade for laparoscopic appendicectomy. Anaesthesia. 2015;70:1395-400.
Mohiuddin K, Swanson SJ. Maximizing the benefit of minimally invasive surgery. J Surg Oncol. 2013; 108(5):315-9.
Garimella V, Cellini C. Postoperative pain control. Clin Colon Rectal Surg. 2013;26(3):191-6.
McDonnell JG, O'Donnell B, Curley G, Heffernan A, Power C, Laffey JG. The analgesic efficacy of transversus abdominis plane block after abdominal surgery: a prospective randomized controlled trial. Anesth Analg. 2007;104:193-7.
Niraj G, Searle A, Mathews M. Analgesic efficacy of ultrasound-guided transversus abdominis plane block in patients undergoing open appendicectomy. Br J Anaesth. 2009;103:601-5.
Shaaban AR. Ultrasound guided transversus abdominis plane block versus local wound infiltration in children undergoing appendectomy: A randomized controlled trial. Egypt J Anaesth. 2014;30:377-82.
Sandeman DJ, Bennett M, Dilley AV, Perczuk A, Lim S, Kelly KJ. Ultrasound-guided transversus abdominis plane blocks for laparoscopic appendicectomy in children: A prospective randomized trial. Br J Anaesth. 2011; 106:882-6.
