Modified thoracoabdominal nerve block through perichondrial approach for laparoscopic appendectomy in children: a randomized trial

Abstract

The modified thoracoabdominal nerve block through perichondrial approach (M-TAPA), an interfascial plane block, effectively induces analgesia in the anterior and lateral thoracoabdominal walls and has demonstrated efficacy in adult patients. However, its application in the pediatric population remains unexplored. This investigation aims to assess the efficacy of M-TAPA in children undergoing laparoscopic appendectomy. Sixty pediatric patients undergoing laparoscopic appendectomy under general anesthesia were enrolled in this single-center study. Preoperatively, the participants were randomly assigned to receive either port-site local anesthetic infiltration or M-TAPA. The primary outcome measure was the numeric rating scale (NRS) pain score assessed 6 hours postoperatively. Secondary outcomes included NRS pain scores at various time intervals, requirement for rescue analgesia, time to first request for rescue analgesics, and incidences of postoperative complications such as nausea, vomiting and shoulder tip pain. The results revealed significantly lower NRS scores in the M-TAPA group compared to the local anesthetic infiltration group, except at the 24-hour mark post-laparoscopic appendectomy (p < 0.05). Additionally, the local anesthetic infiltration group exhibited a higher rate of rescue analgesic usage (53.3%, n = 16) compared to the M-TAPA group (13.3%, n = 4) (p = 0.001). Although the incidences of nausea, vomiting and shoulder pain were elevated in the local anesthetic infiltration group relative to the M-TAPA group, these differences did not reach statistical significance (p > 0.05). In conclusion, M-TAPA demonstrates superior efficacy in postoperative analgesia compared to port-site local anesthetic injection in pediatric laparoscopic appendectomies.