Comparison of caudal epidural block versus transversus abdominis block in lower abdominal surgeries in pediatric age group: an observational study.

Abstrakt

BACKGROUND: Caudal epidural block  is  the  preferred  regional  anesthesia  technique  in  pediatric patients used for a wide variety of surgical procedures. Although  the  caudal  block  provides  effective  analgesia, and is technically less demanding, there  is, however, a risk  of associated  neurological complications. For  this   reason,  practitioners  are exploring  other relatively safer and yet effective analgesic  methods especially in pediatric age group. Transversus  abdominis  plane  block is one such method which is being  increasingly  used  as a safe  and  effective  alternative  to  caudal  epidural block.

BACKGROUND: Caudal epidural block  is  the  preferred  regional  anesthesia  technique  in  pediatric patients used for a wide variety of surgical procedures. Although  the  caudal  block  provides  effective  analgesia, and is technically less demanding, there  is, however, a risk  of associated  neurological   complications. For  this   reason,  practitioners  are exploring  other relatively safer and yet effective analgesic  methods especially in pediatric age group. Transversus  abdominis  plane  block is one such method which is being  increasingly  used  as a safe  and  effective  alternative  to  caudal  epidural block.
OBJECTIVES • To compare the duration and quality of post-operative analgesia in children undergoing lower abdominal surgery receiving transversus abdominis plane block and caudal epidural block.• Compare the occurrence of post-operative complications.• Compare the cumulative doses of diclofenac(in mg) received as rescue analgesia in the two groups.

PARTICIPANTS: 80  pediatric patients belonging to ASA1 and ASA2 classes, in the age group of 2-6 years, undergoing lower abdominal surgeries under general anaesthesia. 
STUDY DESIGN: Prospective observational study

METHODS: The patients were divided into TAP block group  consisting of 34  patients and Caudal epidural block group consisting of 32 patients. Intraoperative vitals were  monitored and recorded.In the post operative period, FLACC pain score was recorded at different intervals in first 24 hours. Need for rescue analgesia and total dose of diclofenac(in mg) was recorded in each group.

RESULTS: Our study showed that TAP block provided superior analgesia at six to twenty-four hours after block placement for lower abdominal surgeries compared to caudal epidural block in pediatric patients. This was demonstrated by statistically significant decrease in requirement of diclofenac consumption for postoperative rescue analgesia in TAP block group. Further it was observed that within the first six hours of post-operative period more number of patients receiving TAP block required rescue analgesia compared to caudal epidural block, but the difference was statistically not significant.

CONCLUSIONS: Ultrasound-guided TAP block and caudal epidural block are effective in management of post operative pain in pediatric patients and either of these methods should be used to control peri-operative pain. 

IMPLICATIONS: Transversus abdominis plane block is a good alternative to caudal epidural block for providing post operative analgesia in children undergoing lower abdominal surgeries.