134 Laparoscopic-assisted Transversus Abdominis Plane Block versus Port-site Infiltration in Appendectomy: A Multicentre Randomised Controlled Trial

Abstract Introduction Transversus abdominis plane (TAP) block has been shown to be an effective technique in providing post-operative analgesia across a range of intra-abdominal surgeries. Laparoscopic-assisted TAP (LTAP) block is a recent advancement of this technique. This study aimed to evaluate the effectiveness of LTAP block compared to port site infiltration (PSI) in patients undergoing laparoscopic appendicectomy. Methods A single-blinded randomised controlled trial was performed to compare LTAP to standard PSI after completing laparoscopic appendicectomy. Patients diagnosed with acute appendicitis, clinically or radiologically, were randomised to either group (1:1). Patients in both groups received the same perioperative analgesic regimen. The primary outcome measure was to compare post-operative pain using a visual-analogue scale (VAS). Secondary outcomes included length of hospital stay (LOS), post-operative opioid requirement and a follow up quality of life (QOL) questionnaire at 1 week and 1 month post discharge. Results A total of 174 patients were enrolled and randomly allocated to the study arms; 85 in LTAP and 82 in control (PSI) group were eligible for analysis. The LTAP group had significantly lower VAS pain scores at 6 hours (p<0.001), 12 hours (p<0.001) and 24 hours (p=0.002) post-operatively. There was no significant difference in VAS scores at 3 hours post-operatively (p=0.1527), in LOS (p=0.45) or in opioid requirements on the ward (p=0.42). QOL scores were better in LTAP group at 1 week follow up (p=0.043). Conclusion LTAP block significantly improved post-operative analgesia outcomes in patients undergoing laparoscopic appendicectomy and holds promise as part of an effective post-operative analgesic regimen.