Ultrasound-guided transversus abdominis plane block versus caudal block for postoperative analgesia in children undergoing inguinal hernia surgery: A comparative study

Abstract

Background and Aims: Ultrasound-guided (USG) transversus abdominis plane (TAP) block has emerged as a safe and effective regional anesthesia technique as it provides adequate postoperative pain relief for lower abdominal surgeries. Caudal block is a gold standard technique in pediatric surgeries. Our aim was to compare the duration of postoperative analgesia between TAP block and caudal block in children undergoing inguinal hernia surgeries. Material and Methods: In a prospective, randomized, controlled study, 112 children of age 2-8 years and ASA grade I and II, undergoing elective inguinal hernia surgery were randomly allocated into two groups: Group T ( n = 56) received USG-guided TAP block with 0.5mL/kg of 0.2% ropivacaine and Group C ( n = 56) received caudal block with 1mL/kg of 0.2% ropivacaine. The primary outcome variable was the duration of postoperative analgesia and the secondary outcome variables included variation in hemodynamic parameters and adverse effects, if any. Results: There was no significant difference in median of CHEOPS score till 5 postoperative hours, thereafter till 24 postoperative hours, significantly lower CHEOPS score were found in Group T. Mean duration of analgesia was 523.44 ± 61.30 min in Group T, whereas in Group C, it was 352.59 ± 32.54 min. No significant difference was observed in hemodynamic variations and adverse effects. Conclusion: TAP block and caudal block both are effective in providing postoperative analgesia in children undergoing inguinal herniotomy. USG-guided TAP block was found to be superior as it provided longer duration of analgesia and reduced rescue analgesic dose without any significant adverse effects as compared with caudal block after inguinal herniotomy.

Analgesic Effects of Regional Analgesic Techniques in Pediatric Inguinal Surgeries: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

“…Finally, 69 eligible RCTs were included for qualitative and quantitative analyses. 22–90 A PRISMA flow diagram of the evidence selection process is presented in Figure 1.…”

TAP block comfort for lower abdominal surgery in pediatric patients

“…The TAP block, which was previously performed using a blind technique but then became more reliable with the introduction of the US, it has become one of the most preferred methods for pain management, especially after pediatric abdominal surgery. A previous study which compares US-guided TAP block and caudal block for postoperative analgesia in children undergoing inguinal hernia surgery shows that the TAP block provided prolonged analgesia and a lower total amount of rescue analgesic consumption 6-24 hours after the block placement compared to caudal block 15 . Priyanka P Karnik et al observed that the pain scores in the TAP block group were considerably lower in the first 2 hours compared to the local infiltration group 16 .…”

Circumcision in children: postoperative analgesic efficiency of transversus abdominis plan block vs caudal epidural block: a prospective observational study

“…USG-guided TAP block was compared with CE block after lower abdominal surgery for postoperative analgesia in one study and was found more effective [8]. In another study, the USG-guided TAP block provided superior analgesia with less demand for rescue analgesia dose than the CE block in children after inguinal herniotomy [6]. As well, in the pediatric patient population, the postoperative analgesic benefits of USG-guided DPNB and CE block were compared after distal hypospadias surgery and circumcision, and in both studies, USG-guided DPNB provided superior analgesia than CE block [20,21].…”

“…With USG guidance, transversus abodominis plane (TAP) block has become a widely used method for surgical anesthesia and postoperative analgesia under anesthesia or sedation, similar to CEA [3,5]. With TAP block, nerves belonging to the T7-L1 spinal afferents responsible for inguinal dermatomal innervation of the body can be blocked in the space between the transversus abdominis and the internal oblique muscles [6]. In providing postoperative pain control, transversus abdominis plane block can produce either equivalent or superior postoperative analgesia to caudal block [5,6].…”

“…With TAP block, nerves belonging to the T7-L1 spinal afferents responsible for inguinal dermatomal innervation of the body can be blocked in the space between the transversus abdominis and the internal oblique muscles [6]. In providing postoperative pain control, transversus abdominis plane block can produce either equivalent or superior postoperative analgesia to caudal block [5,6].…”