Transversus Abdominis Plane Versus Caudal Block for Pediatrics
Condition: Lower Abdominal Surgery
Study type: Interventional
Phase: Phase 1

Summary: 
      The transversus abdominis plane (TAP) block is a relatively simple technique that provides
      myocutaneous anesthesia that, as part of a multimodal analgesic treatment, may be useful in
      the prevention and treatment of parietal postoperative pain.

      Initial experience with ultrasound TAP block demonstrated efficacy of the echo guided
      technique in different surgical procedures such as cesarean section, appendicectomy,
      laparoscopic cholecystectomy, infra umbilical surgery in adult and pediatric patients.
      Recently published clinical trials suggest that TAP block may represents an effective
      alternative to epidural anesthesia but further studies in larger population are necessary.

      Transversus-abdominis plane (TAP) block was found to increase analgesic consumption low
      thoracic-epidural analgesia (TEA) in ischemic heart disease patients after abdominal
      laparotomy (2). Others found comparable results between continuous transversus abdominis
      plane technique and epidural analgesia in regard to pain, analgesic use and satisfaction
      after abdominal surgery(3). The TAP block affords effective analgesia with opioid sparing
      effects, technical simplicity, and long duration of action. Some disadvantages include the
      need for bilateral block for midline incisions and absence of effectiveness for visceral pain
      (4). TAP block has been associated with good pain relief and decreased intraoperative and
      postoperative opioids requirements after laparoscopic surgery (5). The analgesic efficacy of
      the TAP block has been demonstrated in prospective randomized trials compared with placebo,
      in different surgical procedures such as abdominal surgery, hysterectomy, retro pubic
      prostatectomy, Caesarean section, laparoscopic cholecystectomy, and appendicectomy (6, 7, 8,
      9, 5 and 10 respectively). All these studies have reported superiority of the TAP block in
      terms of reduction in visual analogue scale scores and morphine consumption. In this study
      the investigators try to compare Transversus Abdominis Plane (TAP) blocks versus caudal block
      for postoperative pain control after lower abdominal surgeries in pediatrics.
    

Detailed description: 
      Children aged 1-7 years undergoing lower abdominal surgeries would be recruited in this
      randomized study.

      Children would be monitored by electrocardiogram, pulse oximeter and non-invasive blood
      pressure.

      After preoxygenation for three minutes, anesthesia would be induced with 8% sevoflurane
      inhalation in 33% oxygen and 66% nitrous oxide; 1ug/kg fentanyl is administered
      intravenously. Then laryngeal mask is inserted when conditions are satisfactory (jaw relaxed,
      lash reflex disappeared, no coughing, gagging, swallowing).

      Anesthesia would be maintained with 2% sevoflurane and nitrous oxide.

      An increase in blood pressure or heart rate by more than 15% from preoperative value was
      defined as insufficient analgesia and was treated with fentanyl 0.5 µ/kg. Saline dextrose5%
      (1:1) solution was infused in a dose of 12 ml/ kg /h.

      Children were transferred from PACU to day-surgery unit (DSU) if they achieved Modified
      Aldrete Score of ten.

      Patients received rectal paracetamol 15 mg/ kg every 6 hours. Tramadol 1mg/kg is rescue
      analgesic.
    

Intervention name(s): Transversus abdominis plane block; Caudal block; Bupivacaine
Intervention type(s): Other; Other; Drug
Intervention description(s): Children who received transversus aAbdominis plane block with 0.25% bupivacaine with epinephrine 1 mL/kg guided by ultrasound; Children who received caudal 0.25% bupivacaine 1 mL/kg
Intervention MeSH terms: Bupivacaine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Transversus Abdominis Plane; caudal block; postoperative pain; children