Comparing the intraoperative and postoperative analgesic effect of transabdominal block versus caudal block in children undergoing laparoscopic appendectomy

Abstract

Background: Laparoscopic appendectomy is commonly performed in children. Regional anesthesia in children is complementary to general anesthesia, which allows conscious postoperative analgesia and reducing hospital stay. Caudal anesthesia and transverses abdominis plane (TAP) block is commonly used in children because it is easy to practice and provides effective analgesia during surgery. However, its efficacy in laparoscopic appendectomy is not tested much. Aim: The aim of this study is to evaluate the analgesic efficacy of caudal block and TAP block, when used as pre-emptive analgesia using ropivacaine in terms of opioid consumption, postoperative visual analog score (VAS), duration of analgesia, time for rescue analgesia, postoperative nausea, and vomiting and other side effects following elective laparoscopic appendectomy. Methodology: The study design was a prospective, double-blinded, comparative randomized trial on children undergoing laparoscopic appendectomy. Sixty patients between 12 and 18 years were included in the study. They were allocated into any one of two groups of 30 patients each, employing computer-generated randomization. Group I: receive ultrasound-guided caudal block using 0.2% ropivacaine 1 mL/kg. Group II: receive ultrasound-guided TAP block using 0.2% ropivacaine 1 mL/kg. Results: Total intraoperative consumption of opioid fentanyl in Group I is 14.83 ± 18.78 compared to 25.50 ± 17.88 in Group II, which is statistically significant P = 0.028*. VAS score was significantly lower in Group II compared to Group I, P < 0.001**. Conclusion: Caudal block is effective for intraoperative management, whereas TAP block is effective for postoperative management in children undergoing laparoscopic appendectomy.