Surgeon-guided transversalis fascia plane block vs. trocar site wound infiltration in pediatric laparoscopic appendectomy.

Background: Postoperative pain remains a significant concern in pediatric patients undergoing laparoscopic appendectomy. The transversalis fascia plane block (TFPB) is a recently described regional technique. In this study, we aimed to adapt this block into a laparoscopy-assisted approach and compare its analgesic efficacy with conventional wound infiltration in pediatric appendectomy.

Methods: In this prospective, randomized controlled trial, 60 pediatric patients undergoing laparoscopic appendectomy were allocated to receive either laparoscopy-assisted TFPB (n = 30) or standard wound infiltration (WI; n = 30) with 0.25% bupivacaine (0.5 mL/kg). The primary outcome was postoperative pain evaluated via the FLACC (Face, Legs, Activity, Cry, Consolability) scale at seven time points within 24 h. Secondary outcomes included paracetamol consumption and parental satisfaction.

Results: Demographic and perioperative variables were comparable between groups (p > 0.05). Paracetamol was required in significantly fewer patients in the TFPB group (36.7% vs 66.7%, p = 0.038), with fewer requiring repeated doses (13.3% vs 46.7%, p = 0.041). Although FLACC pain scores were statistically comparable between groups (p > 0.05), the TFPB group consistently showed lower median values from the fourth postoperative hour onward. Likewise, parental satisfaction was consistently high in both cohorts, with no significant variation between the analgesic techniques (p = 0.788). No adverse effects or block-related complications were reported.

Conclusion: Laparoscopy-assisted TFPB significantly reduced postoperative analgesic requirements compared to wound infiltration. Given its feasibility, efficacy, and safety, laparoscopy-assisted TFPB technique should be considered an alternative component of multimodal analgesia in pediatric laparoscopic abdominal surgery.