Comparison between Post-Operative Analgesic Efficacy of Low-Concentration High-Volume and High-Concentration Low-Volume Combinations of Ropivacaine for Transverse Abdominis Plane Block in Pediatric Open Inguinal Hernia Repair.

Hyungmook Lee,Haejin Lee,Jaehee Chung,Sungwon Yang,Minsoo Lee

doi:10.3390/jcm8081133

Abstract

Transverse abdominis plane (TAP) block can provide post-operative analgesia in children undergoing open inguinal hernia repair. However, the optimal anesthetic dose, and concentration for TAP block in the pediatric population, is not well defined. This study compared the post-operative analgesic effect of TAP block between low-concentration, with high-volume (LCHV) and high-concentration, with low-volume (HCLV) combinations of local anesthetic. Forty-four patients who underwent open inguinal hernia repair were randomly assigned to two groups. The patients in the LCHV group received 0.67 mL/kg of 0.15% ropivacaine. Whereas, those in the HCLV group received 0.4 mL/kg of 0.25% ropivacaine. Both groups received the same amount of ropivacaine (1 mg/kg). The primary outcome measure was the face, leg, activity, cry, consolability (FLACC) scale score at post-anesthetic care unit (PACU; T1). FLACC scale score at T1 was significantly lower in the HCLV group (2.91 versus 1.43; mean difference, −1.49; 95% confidence interval, −0.0245 to −2.936; p = 0.0464). FLACC scale scores one hour and six hours after the surgery were not different between the two groups. This study reports better post-operative analgesic effects after unilateral open inguinal hernia repair with 1 mg/kg of 0.25% ropivacaine than 1 mg/kg of 0.15% ropivacaine at PACU.

Highlights

Inguinal hernia is a common congenital disease among the pediatric population, and its management requires a surgical repair
The optimal dose and concentration of local anesthetics, required for transverse abdominis plane (TAP) block in the pediatric population, are not well defined, and potentially pJ.oCtelinn.tiMaeldly. 2t0o1x9,i8c, d11o3s3es are frequently administered to children [7]
During the course of the study, one patient from the HCLV group was excluded because of dosing errors, i.e., 0.7 mg/kg of 0.25% ropivacaine was injected for TAP block due to human error

Summary

Introduction

Inguinal hernia is a common congenital disease among the pediatric population, and its management requires a surgical repair. With ultrasound becoming the standard of care for daily practice of anesthesia and analgesia, peripheral nerve blocks are performed more frequently for post-operative analgesia. The optimal dose and concentration of local anesthetics, required for TAP block in the pediatric population, are not well defined, and potentially pJ.oCtelinn.tiMaeldly.

Results

Conclusion