The comparison of ultrasonography guided transversus abdominis plane block and wound infiltration for pediatric inguinal hernia repair: Randomised clinical study

Abstract

ÖZAmaç: Transversus abdominis plan (TAP) blokun postoperatif analjezik etkinliği abdominal cerrahi geçirecek olan hastalarda tartışmalıdır. Bu çalışmanın amacı, inguinal herni tamiri yapı-lan pediyatrik hastalarda ultrasound eşliğinde yapılan TAP blok ile yara yeri infiltrasyonunun analjezik etkinliğini karşılaştırmaktır. Yöntem: Etik onam alındıktan sonra 3-8 yaş arası, tek taraflı inguinal herni onarımı yapılacak olan 60 hasta randomize olarak TAP blok (Grup TAP, n=30) veya yara yeri infiltrasyonu (Grup infiltrasyon, n=30) olarak iki gruba ayrıldı. TAPB grubuna ultrason eşliğinde 0,5 ml/kg olacak şekilde %0,25'lik bupivakain, Grup C'ye ise 0,5 ml/kg olacak şekilde 0,25'lik bupivakain cerrahi öncesi uygulandı. Ağrı skorları (Wong-Baker Yüz Skalası), aile memnuniyeti, blok komplikasyonları ve ek analjezik gereksinimi kaydedildi. Bulgular: İnfiltrasyon grubu ile karşılaştırıldığında, ilk 12 saatteki ağrı skorları TAPB grubunda istatistiksel olarak daha düşüktü (p<0,05). Ek analjezik gereksinimi TAPB grubunda, infiltrasyon grubuna göre istatistiksel olarak daha düşüktü (10/30 vs 18/30 sırasıyla, p=0,038). Aile memnuniyeti TAPB grubunda, Grup infiltrasyona göre istatistiksel olarak daha fazlaydı (p<0,001). Sonuç: TAP bloğun postoperatif analjezik etkinliği tartışmalı olmasına rağmen, pediyatrik inguinal herni tamirinde ultrason eşliğinde uygulanan TAP blok yara yeri infiltrasyonuna göre ağrı skorlarını anlamlı derecede azaltmaktadır.Anahtar kelimeler: Ultrasonografi, transversus abdominis plan bloku, inguinal herni, postoperatif analjezi ABSTRACT Objective: Postoperative analgesic effect of transversus abdominis plane (TAP) block in patients undergoing abdominal surgery has been debatable. The aim of this study was to compare the analgesic effect of ultrasound guided TAP block and wound infiltration in pediatric patients undergoing inguinal herniorrhaphy. Methods: After ethical board approval, 60 children between 3 and 8 years of age undergoing unilateral inguinal hernia repair were randomized to TAP block (Group TAP, n=30) or to wound infiltration (Group infiltration, n=30). Group TAPB received ultrasound-guided TAP block with 0.25% bupivacaine 0.5 ml/kg and Group C received wound infiltration with 0.25% bupivacaine 0.5 ml/kg before surgery. Pain scores (Wong-Baker Faces), parental satisfication, block complications and additional analgesia requirements were recorded. Results: Compared with the infiltration group, the pain scores were statistically lower in the TAPB group during the first 12 hours (p<0.05). The additional analgesia requirement was statistically lower in the TAPB group than Group infiltration group (10/30 vs 18/30 respectively, p=0.038). Parental satisfaction was statistically higher in the Group TAPB than Group infiltration (p<0.001). Conclusion: Despite the postoperative effect of TAP block is debatable; ultrasound-guided TAP block reduces postoperative pain after pediatric inguinal hernia repair compared to wound infiltration.

The Comparasion of ultrasound-guided ilioinguinal/iliohypogastric nerve block and preincision wound infiltration for pediatric inguinal hernia repair: Prospective randomized clinical study

“…[29] A meta-analysis showed that selected pre-emptive analgesia such as epidural analgesia, local wound infiltration, and systemic NSAID administration generally had a beneficial effect from traditional analgesic regimens. [30] In a recent pediatric inguinal hernia repair study, Ahıskalıoğlu et al [31] showed an average of 5.9±3.0 for pain scores in the PWI group up to the first 24 h postoperatively. In a recent study comparing wound infiltration and TAP block, the authors reported the mean pain scores in the PWI group mean mCHEOPS score=7.0, the time of the first analgesic requirement 4.7±1.6 h, and total acetaminophen consumption as 53.0±6.4 mg/ kg.…”

Pediatrik İnguinal Herni Onarımı Sonrası Postoperatif Analjezi: Transvers Abdominis Plan Bloğu veya Caudal Epidural Blok

“…By affecting the ventral ramus of the thoracolumbar nerve, the skin, muscle and parietal peritoneum of the anterior abdominal wall are blocked. Thus, effective analgesia is provided, especially for lower abdominal, gynaecological and urological procedures (9). Caudal epidural block is made by applying local anaesthetic agent to the sacral canal passing the sacrococcygeal ligament, and is an often preferred regional anaesthesia method in pediatric lower extremity, pelvic and below the umbilicus surgical procedures (10).…”

Quadratus Lumborum Block versus Wound Infiltration for Pediatric Unilateral Inguinal Hernia Repair; A Prospective, Randomized Study

“…Most patients can be mobilized, and some suitable patients can be even discharged on the same day of surgery thanks to the implementation of appropriate surgery and analgesia (2) . However, inadequate postoperative analgesia may cause irritability in children due to pain and dissatisfaction in parents and may lead to chronic pain in the later stages of the children's life (3) .…”