Comparison of Laparoscopic-Assisted Transversus Abdominis Plane Block and Trocar-Site Local Anesthetic Infiltration After Laparoscopic Appendectomy: A Randomized Controlled Trial.
5 affiliations
- 1General Surgery, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, TUR.
- 2Surgery, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, TUR.
- 3General Surgery, Istanbul University - Çapa, Istanbul, TUR.
- 4General Surgery, Istanbul Rumeli University, Istanbul, TUR.
- 5Anesthesiology and Reanimation, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, TUR.
Abstract
Background and objective
Abdominal wall blocks are increasingly used for pain control following laparoscopic appendectomy. This study aimed to compare the analgesic efficacy of a transversus abdominis plane (TAP) block performed by the surgical team under direct laparoscopic visualization with trocar-site infiltration using an equal total dose of local anesthetic (LA).Materials and methods
Sixty patients who underwent laparoscopic appendectomy for uncomplicated acute appendicitis between August 2017 and January 2018 were prospectively randomized in a 1:1 ratio into two groups. In the TAP group (n = 30), 15 mL of 0.25% bupivacaine was administered bilaterally under direct laparoscopic visualization before appendectomy. In the LA group (n = 30), 5 mL of 0.5% bupivacaine was infiltrated at each trocar site before incision. The total bupivacaine dose was standardized to 75 mg in both groups. Pain intensity was measured using the visual analog scale (VAS) at postoperative hours 0, 2, 6, 12, and 24. The two groups were compared in terms of rescue analgesic consumption; time to first mobilization, first passage of flatus, and initiation of oral intake; nausea and vomiting; complications; and length of hospital stay.Results
The groups were comparable in terms of age, sex, body mass index, and American Society of Anesthesiologists (ASA) score (all p > 0.05). VAS scores were significantly lower in the TAP group at all measured time points (hour 0, p = 0.005; hour 2, p = 0.022; hour 6, p = 0.020; hour 12, p = 0.020; and hour 24, p = 0.001; effect sizes, r = 0.34-0.49). In the TAP group, 19 of 30 patients (63.3%) required no rescue analgesia during the first 24 hours, compared with 11 of 30 (36.7%) in the LA group (p = 0.039); the total number of nonsteroidal anti-inflammatory drug (NSAID) doses per patient was significantly lower in the TAP group (p = 0.023). Although opioid requirements were numerically lower in the TAP group, the difference did not reach statistical significance (2/30, 6.7% vs. 7/30, 23.3%; p = 0.071). Oral intake was initiated earlier in the TAP group (median, 8.0 vs. 10.0 hours; p = 0.018). The median length of hospital stay was 24.0 hours in the TAP group and 32.0 hours in the LA group (p = 0.002), and the proportions of patients discharged within 24 hours were 16 of 30 (53.3%) and 3 of 30 (10.0%), respectively (p < 0.001). No differences were observed between the groups in mobilization, passage of flatus, or the frequency of nausea and vomiting. No complications related to block administration were observed.Conclusions
A surgeon-performed TAP block under laparoscopic visualization provides lower pain scores and reduces analgesic consumption during the first 24 hours following laparoscopic appendectomy compared with trocar-site infiltration using an equal dose of LA. As it requires neither additional equipment nor ultrasonographic expertise, this technique represents a feasible option in emergency surgical practice.
Related
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BibTeX
@article{tasdelen2026comparison,
title = {{Comparison of Laparoscopic-Assisted Transversus Abdominis Plane Block and Trocar-Site Local Anesthetic Infiltration After Laparoscopic Appendectomy: A Randomized Controlled Trial.}},
author = {İksan Taşdelen and Fatih Kilic and Kemal Memişoğlu and Ahmet Yalin Iscan and Bülent Kaya and Arzu Yildirim Ar},
journal = {Cureus},
year = {2026},
month = oct,
doi = {10.7759/cureus.118156},
url = {https://europepmc.org/article/MED/42898798},
note = {CC BY},
}
RIS
TY - JOUR
TI - Comparison of Laparoscopic-Assisted Transversus Abdominis Plane Block and Trocar-Site Local Anesthetic Infiltration After Laparoscopic Appendectomy: A Randomized Controlled Trial.
AU - İksan Taşdelen
AU - Fatih Kilic
AU - Kemal Memişoğlu
AU - Ahmet Yalin Iscan
AU - Bülent Kaya
AU - Arzu Yildirim Ar
PY - 2026
DA - 2026/10/19
JO - Cureus
DO - 10.7759/cureus.118156
UR - https://europepmc.org/article/MED/42898798
AB - Background and objective Abdominal wall blocks are increasingly used for pain control following laparoscopic appendectomy. This study aimed to compare the analgesic efficacy of a transversus abdominis plane (TAP) block performed by the surgical team under direct laparoscopic visualization with trocar-site infiltration using an equal total dose of local anesthetic (LA).Materials and methods Sixty patients who underwent laparoscopic appendectomy for uncomplicated acute appendicitis between August 2017 and January 2018 were prospectively randomized in a 1:1 ratio into two groups. In the TAP group (n = 30), 15 mL of 0.25% bupivacaine was administered bilaterally under direct laparoscopic visualization before appendectomy. In the LA group (n = 30), 5 mL of 0.5% bupivacaine was infiltrated at each trocar site before incision. The total bupivacaine dose was standardized to 75 mg in both groups. Pain intensity was measured using the visual analog scale (VAS) at postoperative hours 0, 2, 6, 12, and 24. The two groups were compared in terms of rescue analgesic consumption; time to first mobilization, first passage of flatus, and initiation of oral intake; nausea and vomiting; complications; and length of hospital stay.Results The groups were comparable in terms of age, sex, body mass index, and American Society of Anesthesiologists (ASA) score (all p > 0.05). VAS scores were significantly lower in the TAP group at all measured time points (hour 0, p = 0.005; hour 2, p = 0.022; hour 6, p = 0.020; hour 12, p = 0.020; and hour 24, p = 0.001; effect sizes, r = 0.34-0.49). In the TAP group, 19 of 30 patients (63.3%) required no rescue analgesia during the first 24 hours, compared with 11 of 30 (36.7%) in the LA group (p = 0.039); the total number of nonsteroidal anti-inflammatory drug (NSAID) doses per patient was significantly lower in the TAP group (p = 0.023). Although opioid requirements were numerically lower in the TAP group, the difference did not reach statistical significance (2/30, 6.7% vs. 7/30, 23.3%; p = 0.071). Oral intake was initiated earlier in the TAP group (median, 8.0 vs. 10.0 hours; p = 0.018). The median length of hospital stay was 24.0 hours in the TAP group and 32.0 hours in the LA group (p = 0.002), and the proportions of patients discharged within 24 hours were 16 of 30 (53.3%) and 3 of 30 (10.0%), respectively (p < 0.001). No differences were observed between the groups in mobilization, passage of flatus, or the frequency of nausea and vomiting. No complications related to block administration were observed.Conclusions A surgeon-performed TAP block under laparoscopic visualization provides lower pain scores and reduces analgesic consumption during the first 24 hours following laparoscopic appendectomy compared with trocar-site infiltration using an equal dose of LA. As it requires neither additional equipment nor ultrasonographic expertise, this technique represents a feasible option in emergency surgical practice.
SN - 2168-8184
ER -