Lower Abdominal Surgery Clinical Trial
Official title:
Transversus Abdominis Plane (TAP) Blocks Versus Caudal Block for Postoperative Pain Control After Unilateral Lower Abdominal Surgeries in Pediatrics: A Prospective, Randomized Study.
The transversus abdominis plane (TAP) block is a relatively simple technique that provides
myocutaneous anesthesia that, as part of a multimodal analgesic treatment, may be useful in
the prevention and treatment of parietal postoperative pain.
Initial experience with ultrasound TAP block demonstrated efficacy of the echo guided
technique in different surgical procedures such as cesarean section, appendicectomy,
laparoscopic cholecystectomy, infra umbilical surgery in adult and pediatric patients.
Recently published clinical trials suggest that TAP block may represents an effective
alternative to epidural anesthesia but further studies in larger population are necessary.
Transversus-abdominis plane (TAP) block was found to increase analgesic consumption low
thoracic-epidural analgesia (TEA) in ischemic heart disease patients after abdominal
laparotomy (2). Others found comparable results between continuous transversus abdominis
plane technique and epidural analgesia in regard to pain, analgesic use and satisfaction
after abdominal surgery(3). The TAP block affords effective analgesia with opioid sparing
effects, technical simplicity, and long duration of action. Some disadvantages include the
need for bilateral block for midline incisions and absence of effectiveness for visceral
pain (4). TAP block has been associated with good pain relief and decreased intraoperative
and postoperative opioids requirements after laparoscopic surgery (5). The analgesic
efficacy of the TAP block has been demonstrated in prospective randomized trials compared
with placebo, in different surgical procedures such as abdominal surgery, hysterectomy,
retro pubic prostatectomy, Caesarean section, laparoscopic cholecystectomy, and
appendicectomy (6, 7, 8, 9, 5 and 10 respectively). All these studies have reported
superiority of the TAP block in terms of reduction in visual analogue scale scores and
morphine consumption. In this study the investigators try to compare Transversus Abdominis
Plane (TAP) blocks versus caudal block for postoperative pain control after lower abdominal
surgeries in pediatrics.
Children aged 1-7 years undergoing lower abdominal surgeries would be recruited in this
randomized study.
Children would be monitored by electrocardiogram, pulse oximeter and non-invasive blood
pressure.
After preoxygenation for three minutes, anesthesia would be induced with 8% sevoflurane
inhalation in 33% oxygen and 66% nitrous oxide; 1ug/kg fentanyl is administered
intravenously. Then laryngeal mask is inserted when conditions are satisfactory (jaw
relaxed, lash reflex disappeared, no coughing, gagging, swallowing).
Anesthesia would be maintained with 2% sevoflurane and nitrous oxide.
An increase in blood pressure or heart rate by more than 15% from preoperative value was
defined as insufficient analgesia and was treated with fentanyl 0.5 µ/kg. Saline dextrose5%
(1:1) solution was infused in a dose of 12 ml/ kg /h.
Children were transferred from PACU to day-surgery unit (DSU) if they achieved Modified
Aldrete Score of ten.
Patients received rectal paracetamol 15 mg/ kg every 6 hours. Tramadol 1mg/kg is rescue
analgesic.
;
Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Primary Purpose: Treatment
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