Postoperative Analgesia following Pediatric Inguinal Hernia Repair: Transversus Abdominis Plane Block or Caudal Epidural Block

Year 2021, , 206 - 209, 31.08.2021

Çiğdem Ünal Kantekin , Sevgi Ulusoy Tangül , İbrahim Adalı , Gamze Talih

https://doi.org/10.20492/aeahtd.755591

Abstract

PURPOSE: Transversus abdominis plane (TAP) block under ultrasonography and caudal epidural block are techniques used to provide postoperative analgesia in children. The aim of this study was to compare the effect of these two analgesic techniques in pediatric inguinal hernia operations.
MATERIAL AND METHOD: The study included 64 patients aged 4-12 years who underwent surgery for unilateral inguinal hernia. Caudal epidural block was applied to 33 patients (Group C) and TAP block to 31 (Group T). Routine follow-up of postoperative pain for pediatric patients was made with the Wong-Baker faces pain rating scale. A record was made for each patient of the time of requirement for additional analgesia, complications during the intervention and side-effects.
RESULTS: In the evaluation of the faces pain rating scale, the scores of Group C were found to be significantly lower than those of Group T at 6, 8, and 12 hours postoperatively (p=0.04, p=0.03, p=0.03). The duration of postoperative analgesia was found to be mean 220 mins (min-max; 118.65 – 355.3 mins) for Group T, and 351.2 mins (min-max; 167.8-617.65 mins) for Group C. The time of first requirement for additional analgesia was mean 13±4.8 hours in Group C, and 8±3.5 hours in Group T (p=0.02).
CONCLUSION: The application of caudal block provided more effective postoperative analgesia than TAP block applied under ultrasonography guidance in pediatric inguinal hernia repair.

Keywords

Tranversus abdominis plane block, Caudal epidural block, Pediatric inguinal hernia, Postoperative analgesia

Pediatrik İnguinal Herni Onarımı Sonrası Postoperatif Analjezi: Transvers Abdominis Plan Bloğu veya Caudal Epidural Blok

Abstract

abdominis plan (TAP) bloğu ve kaudal epidural blok kullanılır. Bu çalışmanın amacı, bu iki tekniğin pediatrik inguinal herni sonrası analjezi üzerindeki etkisini karşılaştırmaktır.
GEREÇ VE YÖNTEM: Çalışmaya, tek taraflı inguinal herni nedeniyle ameliyat edilen 4-12 yaş arasındaki 64 hasta dahil edildi. 33 hastaya kaudal epidural blok (Grup C) ve 31 hastaya TAP blok (Grup T) uygulandı. Çocuk hastalar için postoperatif ağrının rutin takibi Wong-Baker yüz ağrı derecelendirme skalası ile yapıldı. Her hasta için ek analjezi ihtiyacı, işlem sırasındaki komplikasyonlar ve yan etkiler kayıt altına alındı.
BULGULAR: Wong-Baker skalasına göre postoperatif 6., 8. ve 12. saatlerde grup C değerleri Grup T’ ye göre anlamlı düşük bulundu (p=0.04, p=0.03, p=0.03). Postoperatif analjezi süresi Grup T için ortalama 220 dk (min-max; 118.65 - 355.3 dk) ve Grup C için 351.2 dk (min-max; 167.8-617.65 dk) idi. Ek analjezi için ilk gereksinim süresi C grubunda 13±4.8, T grubunda 8±3.5 saat idi (p=0.02).
SONUÇ: Pediatrik inguinal herni onarımında kaudal epidural blok, ultrasonografi eşliğinde uygulanan TAP bloktan daha etkili postoperatif analjezi sağlamıştır.

Keywords

Transvers abdominis plan blok, , Kaudal epidural blok, Pediatrik inguinal herni, Postoperatif analjezi

References

• 1.) Baird R, Guilbault MP Tessier R, Ansermino JM. A systematic review and meta-analysis of caudal block adeversus alternative analgesic strategies for pediatric inguinal hernia repair. J Pediatr Surg. 2013;48:1077-85.
• 2.) Kendigelen P, Tutuncu AC, Erbabacan E, et al. Ultrasound-assisted transversus abdominis plane block vs wound infiltration in pediatric patient with inguinal hernia: randomized controlled trial. J ClinAnesth. 2016;30:9–14.
• 3.) Sema Şanal Baş. Postoperative Pain in Children. Turkiye Klinikleri J Anest Reanim-Special Topics. 2017;10:154-61.
• 4.) Rafi AN. Abdominal field block: a new approach via the lumbar triangle. Anaesthesia. 2001; 5: 1024–6.
• 5.) Tekelioğlu ÜY, Demirhan A, Koçoğlu H. Transverses abdominis plan (TAP) block. Abant Med J. 2013;2:156-60.
• 6.) Carney J, Finnerty O, Rauf J, Curley G, McDonnell JG, Laffey JG. Ipsilateral transversus abdominis plane block provides effective analgesia after appendectomy in children: a randomized controlled trial. Anesth Analg. 2010;111:998-1003.
• 7.) Carlos R, Estrada JR, Ferrari LR. Core Principles of Perioperative Management in Children. Campbell-Walsh Urology. 7th ed. Philadelphia: Elsevier;2016. p. 2949-62.
• 8.) Visoiu M. Pediatric regional anaesthesia: a current perspective. Curr Opin Anaesthesiol. 2015; 28:577-82.
• 9.) Ahıskalıoğlu A, Yayık AM, Ekinci M. et al. The comparison of ultrasonography-guided transversus abdominis plane block and wound infiltration for pediatric inguinal hernia repair: Randomized clinical study. Journal of Dr. Behçet Uz Children’s Hospital. 2017;7:203-8.
• 10.) Bissonnette B, Dalens B. Regional Anesthetic Tecniques. Wonsiewicz M, Noujaim S, Kurtz S. Pediatric Anesthesia: Principles-practice. New York: McGraw Hill; 2002. p. 541-44.
• 11.) Abdellatif AA. Ultrasound-guided ilioinguinal/ilio hypogastric nerve blocks versus caudal block for postoperative analgesia in children undergoing unilateral groin surgery. Saudi J Anaesth. 2012;6:367-72.
• 12.) Sethi N, Pant D, Dutta A, Koul A, Sood J, Chugh P. Comparison of caudal epidural block and ultrsonography-guided transverses abdominis plane block for pain relief in children undergoing lower abdominal surgery. J ClinAnesth. 2016;33: 322–29.
• 13.) Akın M, Saydam S, Keskin G, et al. Caudal epidural anesthesia in pediatric urological surgery; a single institutional experience with 5536 cases. Bozok Med J. 2015;5:41-5.
• 14.) Shanthanna H, Singh B, Guyatt G. A systematic review and meta-analysis of caudalblock as compared to noncaudal regional techniques for inguinal surgeries in children. Biomed Res Int. 2014;2014:1-17.
• 15.) Begeç Z, Durmuş M, Toprak İH, Köroğlu A, Ülger H, Ersoy MÖ. Caudal Block in Children: Retrospective Investigation of 2262 Cases. Turk J Anaesthesiol Reanim. 2005; 33:388-94.
• 16.) Gavrilovska-Brzanov A, Kuzmanovska B, Kartalov A, et al. Evaluation of Anesthesia Profile in Pediatric Patients after Inguinal Hernia Repair with Caudal Block or Local Wound Infiltration. Maced J Med Sci. 2016;4 (1): 89-93.
• 17.) Long JB, Birmingham PK, De Oliveria GS, Schaldenbrand KM, Suresh S. Transversus abdominis plane block in children; multicenter safety analysis of 1994 cases from the PRAN database. Anesth Analg. 2014;119:395-99.