Comparative study between the analgesic effects of transversus abdominis plane block and caudal block in lower abdominal surgeries in pediatrics compared with general anesthesia

Abstract

Background Pain experienced after abdominal surgery is derived from abdominal wall incision. Transversus abdominis plane (TAP) block is a novel approach for blocking abdominal wall neural afferents. Aim of study To evaluate the analgesic effects of ultrasound-guided TAP block and caudal block in lower abdominal surgeries in pediatrics compared with general anesthesia (GA). Patients and methods This prospective, randomized, controlled, single-blinded study was conducted on 60 pediatric patients of the American Society of Anesthesiologists physical status I and II, aged 2–6 years. Patients were randomized into three equal groups. Groups I and II received ultrasound-guided TAP and caudal block, respectively, whereas group III received GA and opioid analgesia. The primary outcome was intraoperative analgesic effects manifested by changes in hemodynamics and catecholamines. Secondary outcomes included postoperative analgesia and complications. Results There was a highly significant decrease in heart rate 5 min after skin incision in both TAP and caudal groups compared with the GA group. However, there were nonsignificant differences between groups as regards systolic and diastolic blood pressures at baseline and 5 min after skin incision. There was a highly significant decrease in both norepinephrine and epinephrine in TAP and caudal groups compared with the GA group at 5 min after skin incision. Similar findings were reported 60 min after recovery. Postoperatively, Face, Legs, Activity, Cry, Consolability values were significantly higher in the caudal group compared with the GA and TAP groups. The side effects were statistically higher in the GA group. Till 12 postoperative hours the patients who received the TAP block did not require analgesic medication compared to the seven patients who received the caudal block. Patients who received GA significantly required analgesia after 4 h postoperatively. Conclusion Ultrasound-guided TAP block is a good option for providing intra- and postoperative analgesia with no side effects in children undergoing lower abdominal surgeries.

Keywords

• catecholamine
• caudal anesthesia
• general anesthesia
• lower abdominal surgeries
• pain
• pediatrics
• transversus abdominis plane block