Çocuklarda alt batın cerrahisi sonrası postoperative analjezide ultrason yardımlı Transversus abdominis plane blok ile kaudal bloğun karşılaştırılması

Yıl 2020, , 25 - 28, 31.03.2020

Koray Erbüyün , Eralp Çevikkalp , Demet Aydın Tok , Gülay Ok , İdil Tekin

https://doi.org/10.34087/cbusbed.672763

Öz

Giriş ve Amaç: kaudal anestezi çocuklarda alt batın cerrahilerinde postoperative analjezide kullanılan popüler bir tekniktir. Anestezisitler Kaudal bloğun sınırlamalarından ötürü alternatif rejyonel anestezi tekniklerini araştırmak zorunda kalmışlardır. Çalışmamızda; kaudal blok ve ultrason yardımlı TAP bloğun posoperatif analjezide etkinliğini ve güvenilirliğini karşılaştırmayı amaçladık.
Gereç ve Yöntem: Çalışma ASA 1-II, 2-10 yaş aralığında alt batın cerrahisi operasyonu olan hastalarda yapıldı. grup C de (kaudal blok, n: 31), 0,3 mL.kg-1 ve grup T (TAP blok, n: 30), 0,5 mL.kg-1 0,25 % levobupivacaine ameliyat sonrası uygulandı.. Hastalar postoperatif 0., 1., 4., 6. saatlerde revize edilmiş yüzler skalası (FPS-R) kullanılarak ağrı skorları açısından değerlendirildi. Analjezik tüketimi, komplikasyonlar ve yan etkiler kaydedildi. istatistiksel analizlerde Student's t testi, ANOVA, Fisher exact testi kullanıldı.
Bulgular: İki grup arasında demografik verilerde anlamlı bir fark yoktu. TAP bloğu için kullanılan lokal anestezik miktarı kaudal bloktan daha fazlaydı (T: 8,3 ± 4,3> C: 4,1 ± 0,9) (p <0,05). FPS-R'yi 0. saatte karşılaştırdığımızda, TAP bloğu postoperatif ağrıda kaudal bloğa göre daha etkiliydi (p <0,05). Tüm hastaların% 23'ü (n: 14) analjezik gerektiriyordu. İki grup arasında anlamlı fark yoktu
Tartışma ve Sonuç: Sonuç olarak, alt abdominal pediatrik cerrahide postoperatif ağrı yönetiminin erken döneminde TAP bloğu ve kaudal blok basit, güvenli ve etkili analjezik yöntemlerdir

Anahtar Kelimeler

kaudal blok, tap blok, postoperatif analjezi, ultrason, pediatrik

Comparison of Ultrasound-Guided Transversus Abdominis Plane Block vs Caudal Block For Postoperative Analgesia After Lower Abdomen Surgery In Children.

Öz

Introduction. Caudal anesthesia is a very popular postoperative analgesia technique for pediatric lower abdominal surgery. Because of the limitations of caudal block anesthesiologists need to search for alternative regional anesthesia techniques.This study aims to compare the effects and safety of Ultrasound-assisted TAP block and caudal block in postoperative analgesia.
Methods. The study was conducted in ASA grade I-II, 2-10 years aged cases scheduled for lower abdominal surgery. At group C (caudal block , n: 31), 0,3 mL.kg-1 and at group T (TAP block, n: 30), 0,5 mL.kg-1 0,25 % levobupivacaine applied at the end of surgery. Patients were assessed for the quality of pain relief by using faces pain scale-revised (FPS-R) at 0., 1., 4., 6., hours of the postoperative period. Analgesic consumption, complications and adverse effects was recorded. Student’s t-test, ANOVA, Fisher exact test were used for statically analyses.
Results. Between two group there were no significant differences at demographical data. The local anesthetic volume used for TAP block was more than caudal block (T:8,3±4,3 > C: 4,1±0,9) (p<0,05). When we compared the FPS-R at 0. hour, TAP block was more efficient at postoperative pain than caudal block (p<0,05). 23 % off all patients (n:14) required analgesic. There were no significant differences between two groups.
Conclusion: In conclusion TAP block and caudal block are simple, safe and effective analgesic methods in early period of postoperative pain management in lower abdominal pediatric surgery.

Anahtar Kelimeler

caudal block, tap block, pediatric, postoperative analgesia, ultrasound

Kaynakça

• 1. Long JB, Birmingham PK, De Oliveira GS Jr, Schaldenbrand KM, Suresh S. Transversus abdominis plane block in children: a multicenter safety analysis of 1994 cases from the PRAN (Pediatric Regional Anesthesia Network) database. Anesth Analg. 2014; 119(2): 395-9. 2. Wu Y, Liu F, Tang H et al. The analgesic efficacy of subcostal transversus abdominis plane block compared with thoracic epidural analgesia and intravenous opioid analgesia after radical gastrectomy. Anesth Analg 2013;117:507–13. 3. Abdallah FW, Laffey JG, Halpern SH, Brull R. Duration of analgesic effectiveness after the posterior and lateral transversus abdominis plane block techniques for transverse lower abdominal incisions: a meta-analysis. Br J Anaesth 2013;111:721–35. 4. Abdallah FW, Halpern SH, Margarido CB. Transversus abdominis plane block for postoperative analgesia after Caesarean delivery performed under spinal anaesthesia? A systematic review and meta-analysis. Br J Anaesth 2012;109:679–87. 5. Sahin L, Sahin M, Gul R, Saricicek V, Isikay N. Ultrasound guided transversus abdominis plane block in children: a randomised comparison with wound infiltration. Eur J Anaesthesiol 2013;30:409–14. 6. Fredrickson MJ, Paine C, Hamill J. Improved analgesia with the ilioinguinal block compared to the transversus abdominis plane block after pediatric inguinal surgery: a prospective randomized trial. Paediatr Anaesth 2010;20:1022–7. 7. Visoiu M. Paediatric regional anaesthesia: a current perspective. Curr Opin Anaesthesiol. 2015; 28(5): 577-82. 8. Nanze Yu, Xiao Long, Jorge R Lujan-Hernandez, Succar J, Xin X, Wang X.Transversus abdominis-plane block versus local anesthetic wound infiltration in lower abdominal surgery: a systematic review and meta-analysis of randomized controlled trials. BMC Anesthesiol. 2014; 14: 121. 9. Sulagna Bhattacharjee, Manjushree Ray, Tapas Ghose, Souvik Maitra, Amitava Layek. Analgesic efficacy of transversus abdominis plane block in providing effective perioperative analgesia in patients undergoing total abdominal hysterectomy: A randomized controlled trial. J Anaesthesiol Clin Pharmacol. 2014; 30: 391–396. 10. Qingduo Guo, Rui Li, Lixian Wang, Dong Zhang, Yali Ma. Transversus abdominis plane block versus local anaesthetic wound infiltration for postoperative analgesia: A systematic review and meta-analysis. Int J Clin Exp Med. 2015; 8: 17343–17352. 11. Bryskin RB, Londergan B, Wheatley R et al. Transversus Abdominis Plane Block Versus Caudal Epidural for Lower Abdominal Surgery in Children: A Double-Blinded Randomized Controlled Trial. Anesth Analg. 2015; 121: 471-8. 12. Suresh S, Chan VW. Ultrasound guided transversus abdominis plane block in infants, children and adolescents: a simple procedural guidance for their performance. Paediatr Anaesth 2009;19:296–9. 13. 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. 14. Mai CL, Young MJ, Quraishi SA. Clinical implications of the transversus abdominis plane block in pediatric anesthesia. Paediatr Anaesth 2012;22:831–40. 15. McDonnell JG, Curley G, Carney J et al. The analgesic efficacy of transversus abdominis plane block after cesarean delivery: a randomized controlled trial. Anesth Analg 2008; 106:186–91. 16. Warner MA, Kunkel SE, Offord KO, Atchison SR, Dawson B. The effects of age, epinephrine, and operative site on duration of caudal analgesia in pediatric patients. Anesth Analg 1987;66:995–8. 17. Ansermino M, Basu R, Vandebeek C, Montgomery C. Nonopioid additives to local anaesthetics for caudal blockade in children: a systematic review. Paediatr Anaesth 2003;13:561–73.