Unilateral Transversus Abdominis Plane Block in Pediatrics
Condition: Unilateral TAP Block in Pediatric Patients Undergoing Lower Abdominal Surgery
Study type: Interventional

Summary: 
      the present study was designed to compare the efficacy and safety of two different doses of
      dexmedetomidine as an adjuvant to bupivacaine in unilateral TAP block in pediatric patients
      undergoing lower abdominal surgery.
    

Detailed description: 
      After insertion of venous access, all children received premedication in the form of atropine
      at a dose of 0.01-0.02 mg/kg. Perioperative monitoring included continuous ECG, pulse
      oximetry and non-invasive arterial blood pressure. Baseline reading of heart rate, mean
      arterial blood pressure was recorded after monitor attachment.

      General anesthesia will be induced using propofol 1.5-2.5 mg/kg over 20-30 s as tolerated,
      atracurium 0.5 mg/kg to facilitate endotracheal intubation. Anesthesia will be maintained
      using isoflurane (1 MAC) and atracurium 0.1 mg/kg supplements will be given to maintain
      muscle relaxation.

      TAP block will be performed in All patients immediately after induction patients will be
      allocated randomly into three equal groups, 30 patients in each as the following.

      Group 1 (control group) TAP block will be performed using (0.5 ml/ kg bupivacaine 0.25%)
      Group 2 We will carry out TAP block using the same dose of bupivacaine in the control group
      plus dexmedetomidine 0.5 μg / kg as an adjuvant Group (3) In this participants
      dexmedetomidine in dose 1 μg / kg will be given as an adjuvant to the control dose of
      bupivacaine in the TAP block TAP block procedure With the patient in the supine position, the
      site of the ultrasound and needle entry was sterilized. The TAP block will be performed
      laterally behind the midaxillary line between the iliac crest and the most inferior extent of
      the ribs. The plane between the internal oblique and transversus abdominis muscle located
      around the midaxillary line with the probe transverse to the abdomen. Anteriorly, the needle
      passes to come perpendicular to the ultrasound beam and placed between transversus and
      internal oblique posterior to the midaxillary line. Then, the local anesthetic will be
      injected. (Al-Sadek et al.,2014).

      The procedure will be performed immediately after induction of anesthesia by candidate
      anesthesiologist who is not aware of group allocation.

      After completion of surgical procedure anesthesia will be discontinued, muscle relaxant
      reversed using atropine 0.02 mg/kg and 0.05 mg/kg of neostigmine, extubated, and transferred
      to PACU.

      Parameters will be assessed

      • Quality of analgesia will be assessed immediately postoperatively and then at 2, 4, 8, 12
      and 24 h postoperatively using FLACC scale (face,leg,activity,cry and consolability).

      Time to the first analgesic requirement will be recorded from immediately postoperative to
      the time of FLACC score >6. Acetaminophen (perfalgan) 15 mg/kg IV will be given as rescue
      analgesia for patients if FLACC score >6 and total dose of acetaminophen will be recorded.

      • Hemodynamic data including heart rate (HR) and mean arterial blood pressure (MAP).

      Intraoperative any increase in heart rate and or mean arterial blood pressure by more than
      20% of baseline values in response to surgical stimulus or thereafter throughout the whole
      operation warranted administration of intravenous fentanyl (0.5 μg/kg).

        -  postoperative complication including postoperative hypotension or bradycardia (decrease
           in MAP or HR by more than 20% of baseline value), postoperative nausea and vomiting
           (PONV)

        -  length of hospital stays, and patients or parents' satisfaction assessed on a 5-point
           scale (Al-Sadek et al.,2014) 1-completely dissatisfied, 2-dissatisfied, 3-not satisfied
           nor dissatisfied, 4- satisfied 5-completely satisfied
    

Intervention name(s): Bupivacain; Dexmedetomidine o.5 μg; Dexmedetomidine 1 μg
Intervention type(s): Drug; Drug; Drug
Intervention description(s): We will carry out the TAP block using 0.5 ml/ kg bupivacaine 0.25%; We will carry out the TAP block using using 0.5 ml/ kg bupivacaine 0.25% with dexmedetomidine 0.5 μg / kg; We will carry out the TAP block using using 0.5 ml/ kg bupivacaine 0.25% with dexmedetomidine 1 μg / kg
Intervention MeSH terms: Dexmedetomidine; Bupivacaine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment