Clinical effectiveness of transversus abdominis plane block versus local anaesthesia wound infiltration for postoperative pain relief after laparoscopic appendicectomy in children: A multicentre, double-blind, randomised, controlled phase III trial.
Geoffrey Bloy, Amelie Jurine, Sebastien Pili-Floury et al.
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In 30 seconds
This multicentre, double-blind, phase III randomised trial compared ultrasound-guided transversus abdominis plane (TAP) block with local anaesthetic wound infiltration (LAWI) in children aged 3–15 years undergoing laparoscopic appendicectomy. Both approaches were given with standardised multimodal systemic analgesia. Among 46 children analysed in the TAP group and 50 in the infiltration group, median total nalbuphine use within 24 hours was 0.2 [0.0 to 0.2] mg kg−1 in each group (P = 0.95). Pain scores, time to first nalbuphine dose and time to first mobilisation also did not differ significantly.
Key findings
- Median 24-hour nalbuphine dose was 0.2 [0.0 to 0.2] mg kg−1 in both groups (P = 0.95).
- FLACC pain scores did not significantly differ between TAP block and wound infiltration (P = 0.78).
- Time to first nalbuphine dose and first mobilisation did not significantly differ (log-rank P = 0.095 and 0.18, respectively).
Why it matters
The trial directly compares two local anaesthetic techniques in paediatric laparoscopic appendicectomy, with opioid use and pain assessed alongside multimodal analgesia. Its findings suggest that TAP block did not add a measurable opioid-sparing or recovery advantage over trocar-site infiltration in this setting, helping frame the relative value of these approaches without implying that either is ineffective.
What to keep in mind
The study was conducted at two tertiary paediatric surgery centres, and the abstract reports no significant differences between groups; it does not establish equivalence.