Local Infiltration Analgesia Versus Transversus Abdominis Plane (Tap) Block For Postoperative Pain Control In Paediatric Laparoscopic Surgery: A Randomized Controlled Trial

Abstract

Background and Objective: Paediatric laparoscopic surgery, while minimally invasive, is associated with significant postoperative somatic and visceral pain. Effective pain management is crucial for early mobilization and recovery. This study aims to compare the postoperative analgesic efficacy of local infiltration analgesia at port sites versus ultrasound-guided Transversus Abdominis Plane (TAP) block in children undergoing elective laparoscopic procedures. Methodology: A randomized controlled trial was conducted at the Department of Paediatric Surgery. One hundred twenty children aged 2–12 years, scheduled for elective laparoscopy, were enrolled using consecutive sampling and randomized into two equal groups (n=60). Group A received local surgical site infiltration of 0.25% Bupivacaine (2 mg/kg total), while Group B received an ultrasound-guided bilateral TAP block utilizing 0.25% Bupivacaine (0.5 mL/kg per side). Postoperative pain was assessed using the FLACC scale (for children <4 years) or Visual Analog Scale (VAS) at 2, 6, 12, and 24 hours. The primary outcome was the mean pain score, and the secondary outcome was the time to first rescue analgesia. Results: Both groups exhibited comparable baseline demographics. Group B (TAP Block) demonstrated significantly lower mean pain scores at 6 hours (2.1 ± 0.8 vs 4.3 ± 1.1, p < 0.001) and 12 hours (2.5 ± 0.9 vs 4.8 ± 1.2, p < 0.001) compared to Group A. The mean time to first rescue analgesia was significantly prolonged in Group B (540 ± 85 minutes) compared to Group A (310 ± 60 minutes) (p < 0.001). Conclusion: Ultrasound-guided TAP block provides superior, longer-lasting postoperative analgesia and delays the need for rescue analgesics compared to local port-site infiltration in paediatric laparoscopic surgery.