Comparison between Surgeon Administered Intraoperative Transverse Abdominis Plane Block with Wound Site Local Anesthetic Infiltration in Patients Undergoing Open Appendicectomy: A Prospective Double-Blinded Randomised Control Trial

Abstract

Transversus abdominis plane (TAP) block is a defined technique for managing postoperative pain. In particular, the use of surgeon-administered TAP blocks needs more comprehensive research. Therefore, our objective was to record the pain relief needed in patients who underwent surgical administered TAP blocks followed with an open appendectomy in comparison to those who received local anaesthetic infiltration at the wound site. Additionally, we aimed to assess the time until the first postoperative analgesic application and compare tramadol requirements in the postoperative period for these two groups. We conducted a controlled, prospective, randomised, double-blind study involving patients who underwent open appendicectomy at Hospital Sultanah Aminah Johor Bahru from April 2017 to October 2017. Of 61 patients, 31 were in the intervention group, and 30 were in the control group. Both groups of patients received a dose of 10cc of 0.25% levobupivacaine. Patients in the intervention group experienced a longer interval before requiring their first rescue analgesia (2.6 hours versus 1.17 hours; p=0.02, SD=1.66-2.97). The total tramadol dose needed over the first 24 hours in the intervention group was slightly lower at 115.8mg compared to the control group, which used 136.7mg (p=0.32, sd=72.42-89.96). Notably, patients in the intervention group also had a significantly shorter hospital stay (1.39 versus 1.68 days, p=0.02). It was worth noting that none of our patients experienced any adverse events during the study. Considering our study's effectiveness and safety profile, we recommended the routine use of surgeon-administered TAP blocks in open appendicectomy. This approach not only enhanced patient postoperative analgesia but also reduced the duration of hospitalisation.