Efficacy of Laparoscopic-Assisted TAP Block in Laparoscopic Appendectomy

Appendectomy is one of the most frequently performed surgical procedures worldwide and remains the gold standard treatment for acute appendicitis. Although laparoscopic surgery offers advantages such as less pain, faster recovery, and shorter hospital stays compared to open techniques, postoperative pain caused by visceral stimulation from pneumoperitoneum and tissue trauma is still inevitable. Inadequate analgesia delays the recovery process, whereas high-dose opioid use leads to complications such as nausea, vomiting, and respiratory depression. Therefore, within the framework of Enhanced Recovery After Surgery (ERAS) protocols, multimodal analgesia methods and interfacial plane blocks that reduce opioid consumption have gained prominence. The Transversus Abdominis Plane (TAP) block is an effective regional anesthesia technique where a local anesthetic is injected into the fascial plane between the internal oblique and transversus abdominis muscles. Initially described using anatomical landmarks, this method has become widely used with the addition of ultrasound guidance. The TAP block features different modalities, including subcostal, lateral, posterior, dual, and surgeon-performed laparoscopic-assisted approaches. While the subcostal approach targets the supraumbilical (T7-9) region, the lateral and posterior approaches block the infraumbilical (T10-L1) nerve branches. In recent years, the transperitoneal approach, performed by the surgeon under direct vision during laparoscopic surgery, has gained popularity. This technique is performed by advancing the needle through the parietal peritoneum into the transversus abdominis muscle. Due to direct visualization, the risk of visceral injury decreases, and the success rate of delivering the drug to the correct fascial plane increases. This study aims to evaluate and compare the efficacy of surgeon-performed laparoscopic-assisted transversus abdominis plane block versus standard intravenous analgesia in patients undergoing laparoscopic appendectomy.

Inclusion Criteria: * Patients aged between 18 and 65 years * Patients undergoing uncomplicated laparoscopic appendectomy * Patients with American Society of Anesthesiologists physical status I-III Exclusion Criteria: * Presence of appendiceal perforation or complicated appendicitis (such as abscess or peritonitis) * Anatomical abnormalities or deformities of the anterior abdominal wall * Known hypersensitivity or allergy to local anesthetics (such as bupivacaine or amide-type local anesthetics) * Morbid obesity, defined as a Body Mass Index greater than 40 kg/m² * History of opioid, alcohol, or substance abuse or dependence * Active or severe psychiatric illness that may interfere with the study protocol * Inability to communicate in the local language or requiring an interpreter * Known coagulation disorders, bleeding diathesis, or active anticoagulant therapy * Total body weight less than 50 kg * History of cardiac arrhythmia or severe cardiac conduction defects * Pre-existing neurological deficits or peripheral neuropathy at the procedure or injection site * Cognitive impairment, inability to understand the study procedures, or inability to appropriately respond to questionnaires * Pregnancy or lactation * History of major abdominal surgery that may alter the abdominal wall anatomy or laparoscopic visibility