Echoguided transversus abdominis plane block and postoperative pain control in pediatric anesthesia (original) (raw)

European Journal of Anaesthesiology, 2011

Abstract

Background: The transversus abdominis plane block (TAP) is a recently described peripheral nerve block for the sensory nerves in the triangle of Petit before they exit transversus abdominis neuro-fascial plane. This technique of fers a potential advantage over the rectus sheath and ilioinguinal/iliohypogastric nerve blocks thanks to a complete anterior abdominal wall block. In adults it has been shown to reliably decrease postoperative pain scores and opioid requirement in patients undergoing large bowel resection via midline abdominal incision and in women af ter cesarean delivery performed through a Pfannenstiel incision. In our study we demonstrated that ultrasound TAP block (1) was safe and ef ficacious in pediatric population for unilateral inguinal hernia and hydrocele repair together with a reduction in postoperative pain and analgesics requirements. Methods: 46 children (26 males, 20 females) ASA 1 2, 1-10 years old, 9-53 kg, sheduled for unilateral inguinal hernia and hydrocele repair were enrolled in this study af ter informed consent of parents and IRB approval. Under general anesthesia induced with propofol or sevoflurane and maintained with laryngeal mask airway in a mixture of air/O2/sevoflurane all the patients received echoguided TAP Block before surgery. TAP block was performed under realtime ultrasonographic guidance with 0.30 cc/kg of levobupivacaine 0.25%. Muscle relaxants and opioids were not administered. Results: All blocks were successfull and no patient required any analgesics as rescue in postoperative period. Surgeons found that muscular relaxation was similar to that observed af ter the use of neuromuscular blocking agents. The mean duration of postoperative parietal analgesia (time for first analges rescue), evaluted by CHIPPS scale, was 15±2 h. Children had excellent postoperative comfort (moving, coughing, playing and laughing). No complication associated with this ultrasound technique was recorded. Conclusions: Ultrasonography-guided TAP block in pediatric patients are easy to perform, provides consistent post-operative/intraoperative pain relief and may represent an alternative for epidural/caudal anesthesia. References: 1. Suresh S, Chan VW. Ultrasound guided trans versus abdominis plane block in infants, children and adolescents: a simple procedural guidance for their performance. Paediatr Anaesth 2009; 19:296-9

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