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Background and Aims Regional anesthesia is an effective method for post-operative pain management. Current knowledge suggests that lateral transversus abdominis plane block (LTAP) provides post-operative analgesia in patients undergoing open appendectomy. A relatively large volume of LA is required to achieve the adequate analgesic effect. Although the minimum effective volume of LA remains unclear, the tendency is to administer at least 15 ml. This study was designed to determine if lower volumes of LA have the same analgesic efficacy for open appendectomy under general anesthesia.

Methods We performed a prospective randomized, controlled study involving 90 patients undergoing open appendectomy under general anesthesia. Patients randomly assigned to recieve a LTAP by 0.25% bupivacaine at volumes of 10, 15 or 20 ml. The primary outcome was visual analog scale pain scores, and the secondary outcomes were total opioid consumption and time to first rescue medicine.

Results There were statistically significant decreased in pain intensity, opioid consumption and number of patient requiring rescue medicine (P<0.05) in the 20ml group compared to other groups. In addition, all groups exhibited dermatome blockade that covered surgical site.

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Conclusions Despite 20 ml of LA could significantly reducing the pain scores and opioid consumption, a volume of 10 ml of LA was sufficient to provide adequate analgesia after open appendectomy and can be utilized as a multimodal analgesia method.