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This multicenter, double-blind, randomized controlled phase III trial compared transversus abdominis plane (TAP) block to local anesthesia wound infiltration (LAWI) for postoperative pain relief in 96 children (3-15 years old) undergoing laparoscopic appendicectomy. The study found no significant difference in total nalbuphine dose within 24 hours post-surgery, FLACC scale values, time to first nalbuphine dose, or time to first mobilization between the TAP block and LAWI groups. The authors conclude that TAP block does not provide a superior opioid-sparing effect compared to LAWI when combined with systemic multimodal analgesia.
TAP block offers no significant advantage over local wound infiltration for postoperative pain management following pediatric laparoscopic appendectomy when multimodal analgesia is used.
BACKGROUND Postoperative pain relief after laparoscopic appendicectomy in children provided by transversus abdominis plane (TAP) block and local anaesthesia wound infiltration (LAWI) of trocar insertion sites has never been compared. OBJECTIVE To investigate whether TAP block could decrease postoperative opioid requirements after laparoscopic appendicectomy in children compared with LAWI. DESIGN Multicentre, double-blind, phase III randomised trial. SETTING Two tertiary paediatric surgery centres. PATIENTS Children aged 3 to 15 years admitted for laparoscopic appendicectomy. MAIN OUTCOME MEASURES The primary outcome was the total dose of nalbuphine delivered within 24 h after surgery. Secondary outcomes were the Face Legs Activity Cry Consolability (FLACC) scale values at 1, 2, 6, 12 and 24 h, the time from levobupivacaine injection to the first dose of nalbuphine, and the time from the end of surgery to the first mobilisation. Patients received either ultrasound-guided TAP block (TAP group) or LAWI of trocar insertion sites (infiltration group) with 0.6 ml kg-1 of levobupivacaine 2.5 mg ml-1, combined with standardised systemic multimodal analgesia including paracetamol, ketoprofen, phloroglucinol and nalbuphine. RESULTS Forty-six and 50 patients were analysed in the TAP and infiltration groups, respectively [age: 10 [7 to 12] versus 10 [8 to 12] years; females: 16 (35%) versus 25 (50%); duration of surgery: 71 [64 to 90] versus 69 [56 to 89] min]. The primary outcome (total nalbuphine dose) was 0.2 [0.0 to 0.2] and 0.2 [0.0 to 0.2] mg kg-1 in the TAP and infiltration groups, respectively (P = 0.95). FLACC scale values did not significantly differ between the two groups (P = 0.78). Time to the first dose of nalbuphine or to first mobilisation was not significantly different between groups (P value for log-rank test = 0.095 and 0.18, respectively). CONCLUSION TAP block does not appear to provide a greater opioid-sparing effect than LAWI of trocar insertion sites after laparoscopic appendicectomy in children, when combined with systemic multimodal analgesia including nonsteroidal anti-inflammatory drugs. TRIAL REGISTRATION ClinicalTrials.gov NCT04969133.
