Is ultrasound-guided transversus abdominis plane block in providing analgesia in pediatric cases safe and efficient?: A retrospective study

Öz

Objective:  The use of high or insufficient doses of analgesics in pediatric cases unfavorably affects the patient’s health in the postoperative period. Ultrasound-guided transversus abdominis plane (TAP) block is used in the management of postoperative pain in pediatric cases. The present study aims to evaluate the efficacy of ultrasound-guided TAP block in pediatric patients using a mixture of lidocaine and bupivacaine. Methods: The medical records of cases, who underwent surgery for the repair of the inguinal hernia and undescended testis using ultrasound-guided TAP block in the department of pediatric surgery, were retrospectively reviewed (28 cases). The study included ASA I-II pediatric cases aged 2-12 years. The amount of drug administered while performing USG-guided TAP block, time to first analgesic use in the postoperative period, pain score and the amount of first analgesic administration were recorded. The satisfaction of the surgeon and patient’s companion was evaluated. Results: A p-value <0.05 was considered statistically significant. The findings showed that pain score was the lowest in the group with the highest patient’s companion and physician satisfaction score, and the highest in group with the lowest satisfaction score and the difference was statistically significant (p<0.001). The satisfaction of the physicians (p=0.010) and the patient’s companion (p=0.027) increased with increasing drug volume. Conclusions: The volume of 0.4 ml.kg-1 (50:50 1% lidocaine and 2.5% bupivacaine) achieved the best physician and patient’s companion satisfaction and the longest duration of analgesia in pediatric cases undergoing surgery for the repair of the inguinal hernia and undescended testis. The lack of any complications in the present study suggests that USG-guided TAP block is a safe procedure in pediatric patients in experienced hands. Further studies are required.

Anahtar Kelimeler

• Transversus abdominis plane,Ultrasound-guided

Kaynakça

1. 1. El-Dawlatly AA, Turkistani A, Kettner SC, Machata AM, Delvi MB, Thallaj A, Kapral S, Marhofer P. Ultrasound-guided transversus abdominis plane block: description of a new technique and comparison with conventional systemic analgesia during laparoscopic cholecystectomy. Br J Anaesth. 2009 Jun;102(6):763-7. doi: 10.1093/bja/aep067. Epub 2009 Apr 17
2. 2. Hebbard P, Fujiwara Y, Shibata Y, Royse C. Ultrasound-guided transversus abdominis plane (TAP) block. Anaesth Intensive Care. 2007 Aug;35(4):616-7.
3. 3. Fredrickson M, Seal P, Houghton J. Early experience with the transversus abdominis plane block in children. Paediatr Anaesth. 2008 Sep;18(9):891-2. doi: 10.1111/j.1460-9592.2008.02591.x.
4. 4. Apfelbaum JL, Chen C, Mehta SS, Gan TJPostoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg. 2003 Aug;97(2):534-40
5. 5. Dolin SJ1, Cashman JN, Bland JM. Effectiveness of acute postoperative pain management: I. Evidence from published data. Br J Anaesth. 2002 Sep;89(3):409-23.
6. 6. Griffiths JD1, Middle JV, Barron FA, Grant SJ, Popham PA, Royse CF. Transversus abdominis plane block does not provide additional benefit to multimodal analgesia in gynecological cancer surgery. Anesth Analg. 2010 Sep;111(3):797-801. doi: 10.1213/ANE.0b013e3181e53517. Epub 2010 Jun 14.

23. 7. Bharti N1, Kumar P, Bala I, Gupta V. The efficacy of a novel approach to transversus abdominis plane block for postoperative analgesia after colorectal surgery. Anesth Analg. 2011 Jun;112(6):1504-8. doi: 10.1213/ANE.0b013e3182159bf8. Epub 2011 Apr 5.
24. 8. Petersen PL1, Mathiesen O, Stjernholm P, Kristiansen VB, Torup H, Hansen EG, Mitchell AU, Moeller A, Rosenberg J, Dahl JB. The effect of transversus abdominis plane block or local anaesthetic infiltration in inguinal herniarepair: a randomised clinical trial. Eur J Anaesthesiol. 2013 Jul;30(7):415-21. doi: 10.1097/EJA.0b013e32835fc86f.
25. 9. Petersen PL1, Mathiesen O, Stjernholm P, Kristiansen VB, Torup H, Hansen EG, Mitchell AU, Moeller A, Rosenberg J, Dahl JB. The effect of transversus abdominis plane block or local anaesthetic infiltration in inguinal herniarepair: a randomised clinical trial. Eur J Anaesthesiol. 2013 Jul;30(7):415-21. doi: 10.1097/EJA.0b013e32835fc86f.
26. 10. Milone M1, Di Minno MN, Musella M, Maietta P, Iacovazzo C, Milone F. Ultrasound-guided transversus abdominis plane block for retroperitoneal varicocele repair. Could it be an anesthesia method? Updates Surg. 2013 Sep;65(3):225-30. doi: 10.1007/s13304-013-0211-6. Epub 2013 Apr 26.
27. 11. Sola C1, Menace C, Rochette A, Raux O, Bringuier S, Molinari N, Kalfa N, Capdevila X, Dadure C. Ultrasound-guided tranversus abdominis plane block for herniorrhaphy in children: what is the optimal dose of levobupivacaine? Eur J Anaesthesiol. 2014 Jun;31(6):327-32. doi: 10.1097/EJA.0000000000000040.
28. 12. Chen CK1, Teo SC2, Phui VE3, Saman MA2. Analgesic efficacy of transversus abdominis plane block in neonates and early infants for colostomy and reversal of colostomy. Agri. 2015;27(4):210-4. doi: 10.5505/agri.2015.66487.
29. 13. Sahin L1, 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 Jul;30(7):409-14. doi: 10.1097/EJA.0b013e32835d2fcb.