Comparison of Analgesic Efficacy of Ultrasound Guided Ilioinguinal/iliohypogastric Nerve Block and Transversus Abdominis Plane Block in Pediatric Unilateral Lower Abdominal Surgery

Öz

Objective: Regional techniques providing effective postoperative analgesia in pediatrics are controversial. We compared analgesic efficacy of ilioinguinal/iliohypogastric nerve and transversus abdominis plane blocks in children underwent abdominal surgery. Material and Method: In this retrospectively designed study, a total of 60 patients aged between 2 and 12 years who underwent abdominal surgery were divided into two groups: Group I (n=30), which received an ilioinguinal/iliohypogastric nerve block, and Group II (n=30), which received a transversus abdominis plane block. Demographics, intraoperative heart rate, fentanyl consumption, duration of anesthesia and surgery, postoperative pain scores and time to first additional analgesic, number of patients requiring additional analgesia, and complications were recorded. Results: The time to first postoperative analgesia requirement was similar between Group I and Group II (258 ± 135 min and 193 ± 94 min, respectively p=0.369). Demographics, intraoperative fentanyl consumption, duration of anesthesia and surgery were similar in both groups. Intraoperative heart rate and postoperative pain scores at 0th, 1st, and 2nd hours were comparable between the groups. Heart rate decreased significantly from baseline at 15 and 30 minutes within each group. Pain scores decreased significantly at 1st and 2nd hours compared to 0th hour within each group. The number of patients requiring additional analgesia in the first 24 hours postoperatively was similar between the groups. No patients experienced any complications. Conclusion: Ilioinguinal/iliohypogastric nerve and transversus abdominis plane blocks provided similar analgesic efficacy in pain management after pediatric lower abdominal surgery. Both techniques could be preferable regional analgesia methods as part of a multimodal approach in this population.

Anahtar Kelimeler

• Acute postoperative pain
• nerve block
• pediatrics
• regional anesthesia

Pediatrik Tek Taraflı Alt Batın Cerrahisinde Ultrasonografi Eşliğinde Yapılan İlioinguinal/iliohipogastrik Sinir Bloğu ile Transversus Abdominis Plan Bloğunun Postoperatif Analjezik Etkinliğinin Karşılaştırılması

Öz

Amaç: Pediatrik hastalarda etkin postoperatif analjezide rejyonal analjezi yöntemleri tartışmalıdır. Çocuklarda uyguladığımız ilioinguinal/iliohipogastrik sinir ve transversus abdominis plan bloklarının analjezik etkinliklerini karşılaştırmayı amaçladık. Gereç ve Yöntem: Retrospektif olarak planlanan çalışmada abdominal cerrahi geçiren 2-12 yaş arası toplam 60 hasta ilioinguinal/iliohipogastrik sinir bloğu uygulananlar Grup I (n=30), transversus abdominis plan bloğu uygulananlar Grup II (n=30) olmak üzere iki gruba ayrıldı. Demografik veriler, intraoperatif kalp tepe atımı, fentanil miktarı, anestezi ve cerrahi süreleri, hastaların postoperatif ağrı skorları ile ilk analjezi ihtiyacına kadar geçen süre, ek analjezik ihtiyacı olan hasta sayısı ve komplikasyonlar kaydedildi. Bulgular: Postoperatif ilk analjezi gereksinimi Grup I ve Grup II arasında benzerdi (sırasıyla 258 ± 135 dakika ve 193 ± 94 dakika p=0.369). Demografik veriler, intraoperatif fentanil tüketimi, anestezi ve cerrahi süreleri iki grupta benzerdi. İntraoperatif kalp atım hızı ve postoperatif 0., 1. ve 2. saatlerdeki ağrı skorları gruplar arasında benzer bulundu. Grup içi analizlerinde her bir grupta kalp atım hızında 15. ve 30. dakikalarda başlangıç değerlerine göre anlamlı düşüş görüldü. Postoperatif ağrı skorları grup içi karşılaştırıldığında 1. ve 2. saatlerde 0. saate göre azalma gözlendi. Grup içi kalp atım hızı ve ağrı skorlarının zaman içerisinde gösterdiği değişimler gruplar arasında benzerdi. Postoperatif ilk 24 saatte ek analjezi ihtiyacı olan hasta sayısı gruplar arasında farklılık göstermedi. Hastalarda herhangi bir komplikasyona rastlanmadı. Sonuç: İlioinguinal/iliohipogastrik sinir ve transversus abdominis düzlem blokları, pediatrik alt batın cerrahisi sonrası ağrı yönetiminde benzer analjezik etkinlik sağlamıştır. Çocuk popülasyonunun multimodal analjezi yaklaşımında her iki teknik de tercih edilebilir bölgesel analjezi yöntemleri olabilir.

Anahtar Kelimeler

• Akut postoperatif ağrı
• pediatri
• rejyonal anestezi
• sinir blok

Kaynakça

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