Abstract PR267

Abstract

Background & Objectives: Caudal epidural block (CEB) is a commonly performed neuraxial technique for providing analgesia in children scheduled for lower abdominal surgery. Although the efficacy of CEB is fairly high,the associated complications,such as, inadvertent dural puncture, unwarranted lower limb motor blockade,and bladder function disturbance limits its use.While the advantages of ultrasound-guided Transversus Abdominis Plane(TAP) block such as reduction in pain intensity/analgesic requirements is well documented in adults post-surgery, in children, its use as a primary postoperative analgesia technique remains limited.We conducted this randomized controlled trial to compare the efficacy of CEB versus ultrasound-guided TAP block for providing postoperative analgesia in children undergoing lower abdominal surgery.The primary objective of our study was to compare the duration-of- postoperative analgesia. The secondary objectives were comparative assessment (TAP vs CEB) of quality of postoperative pain relief, and rescue analgesia requirements. Materials & Methods: Eighty-children, aged 2-6 years, of ASA physical status I/II, scheduled to undergo unilateral lower abdominal surgery under general anaesthesia (GA) were recruited in this prospective randomized-controlled study.The children were randomly allocated to receive either CEB (Group-C, 0.75-ml/kg of 0.25% bupivacaine) or ultrasound-guided TAP block (Group-T, 0.5-ml/kg of 0.25% bupivacaine).Intraoperatively:heart rate and non-invasive blood pressure, and postoperatively:duration-of-postoperative analgesia,quality-of-pain relief, and rescue analgesia requirements were recorded. Results: The median duration-of-postoperative analgesia in children who received CEB was significantly greater than those who were administered TAP block (group-C:362.5-minutes versus group-T:210-minutes; p<0.05). No difference was found in the incidence of ‘early’ postoperative pain (group-C:47.2% versus group-T:55.9%; p>0.05). The children who received CEB experienced greater incidence of ‘late’ postoperative pain than those administered TAP-block (group- C:75% versus group-T:44.1%; p<0.05).The number of children not requiring any rescue analgesia in the first 24-hours postoperatively were significantly higher in the ‘TAP’ group (group-C:n=2 versus group-T: n=8; p<0.05). Conclusion: In children undergoing unilateral lower abdominal surgery, while, CEB provides a significantly prolonged duration-of-analgesia, ultrasound-guided TAP block seems to be superior to CEB for late postoperative pain relief. Study published in journal of clinical anesthesia.