Laparoscopic-assisted transversus abdominis plane block versus port-site infiltration in appendicectomy - multicentre randomized clinical trial

Q: What was the aim of the trial?

To evaluate whether laparoscopic-assisted TAP (LTAP) block was more effective than port-site infiltration (PSI) of local anaesthetic for patients undergoing laparoscopic appendicectomy.

Q: How were patients assigned and what was the primary outcome?

Patients were randomized 1:1 to LTAP block or PSI. The primary outcome was postoperative pain assessed using a visual analogue scale (VAS).

Q: What did the results show about pain and opioid use?

VAS pain scores were statistically significantly lower with LTAP on time-weighted analysis, with significant improvements at 6 h and 12 h. Oxycodone requirements were also significantly reduced in the LTAP group.

Sep 30, 2026

Uploaded by Anna Hans

Transversus abdominis plane (TAP) block is used for postoperative analgesia across intra-abdominal surgeries, and laparoscopic-assisted TAP (LTAP) block is a newer development. This single-blinded randomized clinical trial compared LTAP block with port-site infiltration (PSI) of local anaesthetic in patients undergoing laparoscopic appendicectomy. Primary analysis showed lower time-weighted postoperative pain on VAS with LTAP. Improvements were significant at 6 h and 12 h, with reduced oxycodone requirements, supporting LTAP as an effective early analgesic option and part of postoperative pain regimens.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusion

Introduction

BJS, 2026, znaf257 [https://doi.org/10.1093/bjs/znaf257](https://doi.org/10.1093/bjs/znaf257) Randomized Clinical Trial Laparoscopic-assisted transversus abdominis plane block versus port-site infiltration in appendicectomy: multicentre randomized clinical trial Gordon R. Daly1,2,*†, Gavin P. Dowling1,2,† , Sandra Hembrecht1,2 , Sorcha O’Grady1,2, Aisling Hegarty1,2, Trudi Roche1,2, Gabriel Orsi1,3, Arielle Pierre1,4, Gavin G. Calpin1,2 , Colm Neary1,3, Cian M. Hehir1,2, Gerard J. Hill1,2, Abigail O’Brien1,4, William P. Duggan1,2 , Matthew G. Davey1,2, Ian J. B. Stephens1,2, Niall D. Kennedy1,2, Oisín Brennan1,4, Cathal Hayes1,2, Mohammed Al Azzawi1,2, Ishwarya Balasubramanian1,2, Andrew McGuire1,2, Alexandra M. Zaborowski1,2, Ian S. Reynolds1,2, Paula Loughlin1,2,3, Michael Allen1,2,3, Colm Power1,2, Abeeda Butt1,2, Michael R. Boland1,2, Niamh McCawley1,2, John P. Burke1,2, William B. Robb1,2, Achille Mastrosimone1,3, Mayilone Arumugasamy1,2,3, Hugo Prins1,3, David Beddy1,2,3, Michael J. Kerin1,4, Deborah A. McNamara1,2, David Kearney1,2,3, Jan Sorensen5, Gerard F. Curley1,2,6, Sami Abd El Wahab1,2,4 and Arnold D. K. Hill1,2 1Department of Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland 2Department of Surgery, Beaumont Hospital, Dublin, Ireland 3Department of Surgery, Connolly Hospital, Dublin, Ireland 4Department of Surgery, Galway University Hospital, Galway, Ireland 5School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland 6Department of Anaesthesia and Critical Care, Beaumont Hospital, Dublin, Ireland *Correspondence to: Gordon R. Daly, Department of Surgery, RCSI University of Medicine and Health Sciences, 123 St. Stephen’s Green, Dublin D02 YN77, Ireland (e-mail: [gordondaly@rcsi.com](gordondaly@rcsi.com)) †Joint first authors (contributed equally) 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.clinicaltri

FAQs

What was the aim of the trial?

To evaluate whether laparoscopic-assisted TAP (LTAP) block was more effective than port-site infiltration (PSI) of local anaesthetic for patients undergoing laparoscopic appendicectomy.

How were patients assigned and what was the primary outcome?

Patients were randomized 1:1 to LTAP block or PSI. The primary outcome was postoperative pain assessed using a visual analogue scale (VAS).

What did the results show about pain and opioid use?

VAS pain scores were statistically significantly lower with LTAP on time-weighted analysis, with significant improvements at 6 h and 12 h. Oxycodone requirements were also significantly reduced in the LTAP group.

Sep 30, 2026

Uploaded by Anna Hans