TAPB vs. Caudal for Lower Abdominal Surgery in Children: A Double-Blinded Randomized Controlled Trial

Study Overview
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Brief Summary
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Transversus abdominis plane block (TAPB) has emerged as a safe and effective regional anesthesia technique for providing postoperative lower abdominal analgesia. Complications associated with TAPB are very rare and pose a lower overall risk to the patient receiving a TAPB versus a caudal block, which is considered the gold standard for pediatric lower abdominal regional anesthesia. Our study hypothesis was that TAPB would be equivalent to caudal block initially in providing postoperative pain control but would show improved pain relief beyond the anticipated caudal duration.

Detailed Description
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The study design was a double-blinded randomized controlled trial. A minimum of 44 children between the ages of 1 and 9 undergoing bilateral ureteral reimplantation surgery through a low transverse incision will be enrolled. Narcotic requirement, pain scores (FLACC/FACES), episodes of nausea/vomiting, and anti-spasmodic requirement will be recorded in the PACU and at 6 hour intervals through 24 hours from the time of the block placement.

Official Title
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Transversus Abdominis Plane Block Versus Caudal Epidural for Lower Abdominal Surgery in Children: A Double-Blinded Randomized Controlled Trial

Conditions
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Anesthesia, Recovery Period

Intervention / Treatment
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* Procedure: Caudal Epidural
* Procedure: Transversus Abdominis Plane Block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients aged 1 to 9 years old scheduled for intravesicular ureteral reimplantation surgery Exclusion Criteria: Coagulation status or anatomic variations precluded safe placement of either TAPB or caudal epidural, there was a preexisting chronic pain disorder, there was a history of constipation that persisted despite appropriate treatment and that may have impacted postoperative pain assessments, additional procedures were planned via a separate incision at the time of the ureteral reimplantation, 5) there was a contraindication to receiving the medications described in the protocol.

Ages Eligible for Study
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Minimum Age: 1 Year
Maximum Age: 9 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Transversus Abdominis Plane Block<br>Transversus Abdominis Plane Block TAPB Ultrasound guided TAPB | Procedure: Transversus Abdominis Plane Block<br>* Ultrasound Guided Transversus Abdominis Plane Block<br>|
| Experimental: Caudal Epidural Block<br>Caudal Epidural Block Caudal Block Neuraxial Block Ultrasound Guided Caudal Block | Procedure: Caudal Epidural<br>* Ultrasound Guided Caudal Block<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Narcotic requirement | Narcotic requirement was recorded at 24 hours from the time of the block placement. | 24 hours post intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| episodes of nausea/vomiting | Episodes of nausea/vomiting were recorded at 24 hours from the time of the block placement. | 24 hours | 
| anti-spasmodic requirement | Anti-spasmodic requirement were recorded at 24 hours from the time of the block placement. | 24 hours post intervention | 
| Pain Scores | Pain scores (FLACC/FACES) were recorded at 24 hours from the time of the block placement | 24 hours post intervention | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Transversus Abdominis Plane Block, Caudal Epidural, Pediatric Pain control, Pain control for Lower Abdominal Surgery