Comparison of Efficiencies of Laparoscopic Transversus Abdominis Plane Block and Local Anesthesia at Trocar Site After Laparoscopic Appendectomy

Abstract

Objective: The most common operation performed in the general surgery practice is appendectomy. With the spread of laparoscopy, minimally invasive procedures have become more preferable and less pain, early mobilization, early return to work and better cosmetic results have been obtained in the postoperative period. A method for reducing postoperative pain is the ultrasound-guided transversus abdominis plane (TAP) block. The aim of this study was to compare the efficacy of local anesthetic (LA) infiltration in the trocar site with transversus abdominis plane block performed under direct laparoscopic view without using ultrasound in patients undergoing laparoscopic appendectomy for acute appendicitis. Material and Methods: The patients who underwent laparoscopic appendectomy due to the diagnosis of appendicitis in the Department of General Surgery at Health Sciences University, Fatih Sultan Mehmet Education and Research Hospital between August 2017 and January 2018 were randomized into two groups. Group 1 was performed TAP block under laparoscopic view and Group 2 was performed LA infiltration in the trocar site. The pain levels of the patients were calculated by using visual analogue score (VAS) at the postoeprative 0th, 2nd, 6th, 12th and 24th hours. The duration of operation, postoperative nausea and vomiting complaints, the first times of gas-stool discharge, the first times of mobilization, duration of hospital stay, and the doses of nonsteroidal analgesic drugs and opioids were recorded and compared. The statistical analysis was performed using SPSS version 20.0 software. The p values below 0.05 were evaluated as statistically significant. Results: There was no significant difference between the groups in terms of age, gender, BMI and ASA scores (p> 0.05). The VAS values recorded at 0th, 2nd, 6th, 12th and 24th hours were significantly lower in the TAP block group than in the trocar site group. The duration of hospital stay in the TAP block group was detected to be shorter (p: 0.002). Moreover, analgesic consumption in TAP block group was lower compared to the trocar site group (p: 0,023). Conclusion: The TAP block method applied by surgeon during laparoscopic appendectomy is more effective than local anesthesia application in the trocar site. Due to decreased analgesic use, intestinal movements may be returned in the early period and this may shorten the length of hospitalization.