Comparative Study of Ultrasound - Guided Transversus Abdominis Plane Block Versus Ilioinguinal/Iliohypogastric Nerve Block& Local Wound Infiltration for Post Operative Analgesia in Inguinal Hernia in Paediatrics

Abstract

Postoperative management of pain in pediatric population is of major concern as it reduces the incidence of complications and leads to earlier hospital discharge. to evaluate efficacy of ultra-sound guided transverses abdominus plane block versus local anaesthetic wound infiltration versus ultra-sound guided ilioinguinal /iliohypogastric nerve block with or without using of dexmedetomidine as an additive to bupivacaine, in the management of the postoperative pain in pediatric patients undergoing unilateral inguinal hernia repair. This prospective randomized blinded, controlled, clinical study,in which 140 Patients were randomized into four groups, The primary targets of this current study were FLACC score for pain and measuring the mean paracetamol consumption in 24 hours. Regarding comparison between the four groups involved in our study , the postoperative analgesia is more effective with TAP group [ the gold standard ] than groupII,groupIII and groupIV, the latter is being the least effective in postoperative pain control . Also the postoperative consumption of paracetamol in TAP group is lower than other groups.Using dexmedetomidine as an additive to bupivacaine provides prolonged duration of postoperative analgesia, and lowered FLACC pain scores. As regard demographic data were not significantly different between the groups . Vital parameters [heart rate, systolic and diastolic blood pressure, respiratory rate per minute] were also not significantly different between the groups. ultra-sound guided transverses abdominus plane block is more effective in postoperative analgesia when compared to local anaesthetic wound infiltration and ultrasound guided ilioinguinal /iliohypogastric nerve block. Using dexmedetomidine as an additive to bupivacaine provides prolonged duration of postoperative analgesia, and lowered FLACC pain scores.