Re: Long-Term Followup of Children with Nocturnal Enuresis: Increased Frequency of Nocturia in Adulthood

Abstract

In our study the TAP blocks were performed according to the technique described by Suresh and Chan, 3 in which the local anesthetic is deposited at the extreme lateral border of the junction of the TAP and the latissimus dorsi muscle. We also directed the injection superiorly, as close to the costal margin as possible, to reach a high thoracic nerve level. Thus, we believe our technique is similar to that of McDonnell et al, 7 albeit at a more superior level. Ultimately we agree that one cannot always guarantee adequate spread of local anesthetic to all necessary thoracic nerves, particularly some lateral cutaneous branches. However, we propose that our ultrasound guided TAP blocks, using relatively large volumes of local anesthetic, achieved a reasonable sensory blockade in most patients in our study, althoughdsimilar to any other regional analgesic blocksdthe quality of analgesia differed from patient to patient due to other factors (such as anatomical variations and loss of local anesthetic during dissection of the planes). We also recognize the possible benefits of a more posterior approach, such as the tranversalis fascia plane block. 6 We hope the results of our parallel group, randomized, controlled trial prompt other investigators to explore the effectiveness of these techniques against regional infiltration in a prospective systematic fashion.Lastly we wish to reemphasize the primary finding in our report, that surgeon provided local infiltration works quite well! Any intervention attempting to outperform this technique has to provide equivalent or superior results while displaying some advantages. With modern open pyeloplasty in infants and young children being routinely done with a small, muscle splitting incision, a broad block covering multiple dermatomes may not be justifiable or needed.