Transversus abdominis plane block improved surgical conditions in neuromuscular blocker-free pediatric laparoscopic hernia repair: a randomized trial

Background: Pediatric laparoscopic hernia repair (LHR) is a short, commonly performed ambulatory procedure that can be conducted under general anesthesia without neuromuscular blocker (NMB). This prospective randomized controlled trial evaluated whether a transversus abdominis plane (TAP) block facilitates the implementation of NMB-free anesthesia in this surgical setting. Methods: Eighty pediatric patients scheduled for LHR without NMB were stratified by age (≤ 3 or > 3 years) and randomized to receive either a bilateral TAP block after induction (TAPB group) or surgical-site local infiltration at closure (Control group). The primary outcome was the mean intraoperative Leiden Surgical Rating Scale (L-SRS) score. Results: The TAPB group demonstrated significantly higher mean L-SRS scores compared with controls (mean difference, 0.9; 95% CI, 0.69–1.11; p < 0.001), consistent across age subgroups. Age-stratified analysis revealed a markedly increased risk of intraoperative hemodynamic stress responses in the Control group, with adjusted odds ratios of 10.09 (95% CI, 3.46–29.42; Cochran’s p < 0.001) for mean arterial pressure elevation ≥ 15% and 4.78 for heart rate elevation ≥ 15%, as well as a higher need for remifentanil rescue (adjusted odds ratio, 10.09; 95% CI, 3.44–29.60; Cochran’s p < 0.001). The TAPB group also exhibited improved postoperative recovery, with significantly lower rates of emergence delirium (10 vs. 37.5%), moderate-to-severe pain (37.5 vs. 80%), and postoperative fentanyl rescue (2.5 vs. 20%; all p < 0.05). Conclusion: The addition of a TAP block significantly improved surgical conditions during pediatric LHR under an NMB-free general anesthesia strategy, while attenuating stress responses and enhancing postoperative recovery quality. © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2026.