Ipsilateral Transversus Abdominis Plane Block Provides Effective Analgesia After Appendectomy in Children: A Randomized Controlled Trial

BACKGROUND: The transversus abdominis plane (TAP) block provides effective postoperative analgesia in adults undergoing major abdominal surgery. Its efficacy in children remains unclear, with no randomized clinical trials in this population. In this study, we evaluated its analgesic efficacy over the first 48 postoperative hours after appendectomy performed through an open abdominal incision, in a randomized, controlled, double-blind clinical trial. METHODS: Forty children undergoing appendectomy were randomized to undergo unilateral TAP block with ropivacaine (n = 19) versus placebo (n = 21) in addition to standard postoperative analgesia comprising IV morphine analgesia and regular diclofenac and acetaminophen. All patients received a standard general anesthetic, and after induction of anesthesia, a TAP block was performed using the landmark technique with 2.5 mg . kg(-1) ropivacaine 0.75% or an equal volume (0.3 mL . kg(-1)) of saline on the ipsilateral side to the incision. RESULTS: The TAP block with ropivacaine reduced mean (+/-SD) morphine requirements in the first 48 postoperative hours (10.3 +/- 12.7 vs 22.3 +/- 14.7 mg; P < 0.01) compared with placebo block. The TAP block also reduced postoperative visual analog scale pain scores at rest and on movement compared with placebo. Interval morphine consumption was reduced over the first 24 postoperative hours. There were no between-group differences in the incidence of sedation or nausea and vomiting. There were no complications attributable to the TAP block. CONCLUSIONS: Unilateral TAP block, as a component of a multimodal analgesic regimen, provided superior analgesia compared with placebo in the first 48 postoperative hours after appendectomy in children. (Anesth Analg 2010;111:998-1003)