Caudal Block and Transversus Abdominis Plane Block in Pediatric Inguinal Hernia Repair
Condition: Regional Anesthesia; Postoperative Pain, Acute
MeSH terms: Pain, Postoperative; Hernia, Inguinal; Acute Pain
Study type: Interventional

Summary: 
      Pediatric inguinal hernia repair (IHR) candidates experiences ordinarily mild to moderate
      pain, rarely severe pain in the postoperative period. Caudal epidural block (CEB) and
      transversus abdominis plane block (TAPB) are two effective postoperative analgesia options.
      In this randomized study, it is aimed to compare the effects of CEB and TAPB on postoperative
      pain scores, additional analgesic requirement, postoperative nausea and vomiting incidence,
      procedural complications, family and surgeon satisfaction, length of hospital stay, chronic
      pain development in pediatric bilateral open IHR.
    

Detailed description: 
      Inguinal hernia repair (IHR) is the second common operation in pediatric surgery practice
      following appendectomy and bilateral repair is needed in 10.9% of the cases due to presence
      of contralateral inguinal hernia. After IHR, the children generally experiences mild to
      moderate pain, and occasional severe pain. For pediatric population the prevalence of chronic
      pain after IHR is 5% which is a solid cause for severe pain.

      Adequate pain control is a crucial part of perioperative management to reduce morbidity and
      ensure family and patient satisfaction especially after pediatric surgeries. Although there
      are substantial studies to show how to assess and manage the postoperative pain in children,
      the pain control is often not achieved. Several analgesic regimens including systemic
      medications and/or regional analgesia methods may be preferred by clinicians. As previous
      studies revealed; best combination for pain management after pediatric IHR is still obscure.

      Caudal epidural block (CEB) and transversus abdominis plane block (TAPB) are the two regional
      analgesia methods which may be chosen for multimodal analgesia. CEB is accepted as gold
      standard for lower abdominal surgeries in children which diminishes somatic and visceral pain
      with a duration of 6 hours. TAPB is another regional analgesia method which covers only
      somatic pain up to 24 hours postoperatively with lower complication rates compared to CEB.
      The results of clinical studies examining the effects of CEB and TAPB on early postoperative
      pain after pediatric IHR are conflicting. Currently, the effects of these blocks on the
      incidence of chronic pain after pediatric IHR is not well-investigated in the literature. As
      a matter of fact, there are no recommendations for bilateral IHR in pediatric postoperative
      pain guidelines, despite these surgical procedures being an independent risk factor for
      severe pain.

      In this randomized study, it is aimed to compare the effects of ultrasound (US) guided CEB
      and TAPB on postoperative analgesia. Our hypothesis was that bilateral TAPB block will be
      equally effective as CEB in the early postoperative period and the analgesic duration will be
      longer than CEB. Our primary outcome was FLACC (face, legs, activity, cry, consolability)
      scores in postoperative 24 hours. The secondary outcomes included additional analgesic
      requirements, postoperative nausea vomiting incidence, procedural complications, length of
      hospital stay, family and surgeon satisfaction and chronic pain development at the
      postoperative 2nd month.
    

Intervention name(s): Bupivacaine 0.25% Injectable Solution
Intervention type(s): Drug
Intervention description(s): Bupivacaine 0.25% Injectable Solution
Other intervention name(s): Marcaine
Intervention MeSH terms: Bupivacaine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Prevention
Keywords: US guided Caudal Epidural Block; US guided Transversus Abdominis Plane Block