Ultrasound-guided transversus abdominis plane block in children: a randomised comparison with wound infiltration

Levent Sahin, Mehrican Sahin, Rauf Gul, Vahap Saricicek, Nurgul Isikay
European Journal of Anaesthesiology 2013, 30 (7): 409-14

CONTEXT: The transversus abdominis plane (TAP) block is a new regional anaesthesia technique applicable to infants and children.

OBJECTIVE(S): The present study was designed to evaluate the analgesic efficacy of ultrasound-guided TAP block with high volume local anaesthetic (0.5  ml kg) during the first 24 h after surgery in children undergoing inguinal hernia repair.

DESIGN: Randomised comparative study.

SETTING: Gaziantep University Hospital between December 2010 and May 2011.

PATIENTS OR OTHER PARTICIPANTS: Fifty-seven children between 2 and 8 years of age undergoing unilateral inguinal hernia repair were randomised to TAP block (group T, n = 29) or to wound infiltration (group C, n = 28).

INTERVENTION(S): A TAP block using ultrasound guidance with 0.25% levobupivacaine 0.5  ml kg(-1) or wound infiltration with 0.2  ml kg(-1) 0.25% levobupivacaine, was performed on the same side as the hernia under general anaesthesia.

MAIN OUTCOME MEASURES: Time to first analgesic, cumulative number of doses of analgesic, pain scores and adverse effects were assessed over the course of 24  h.

RESULTS: The time to first analgesic (mean ± SD) was significantly longer in group T than in group C (17 ± 6.8 vs. 4.7 ± 1.6 h, respectively; P < 0.001). Thirteen (45%) patients in group T did not require any analgesic within the first 24 h. The cumulative number of doses of analgesic was significantly lower in group T than in group C (1.3 ± 1.2 vs. 3.6 ± 0.7, respectively, P < 0.001). Pain scores were significantly different between the groups at all time points except at 1, 20 and 24  h (P < 0.001).

CONCLUSION: Ultrasound-guided TAP block with high volume (0.5 ml kg) 0.25% levobupivacaine provides prolonged postoperative analgesia and reduced analgesic use without any clinical side-effects after unilateral hernia repair in children.

TRIAL REGISTRATION: ACTRN12611000585921 (7/06/2011) from Australian New Zealand Clinical Trials Registry.

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