Different postoperative analgesic effects of transversus abdominis plane block with three approaches in pediatric lower abdominal surgery

Abstract

Objective To observe the different effect of transversus abdominis plane block (TAP) with three approaches for postoperative analgesia in pediatric lower abdominal surgery. Methods Ninety children with lower abdominal operation from People's Hospital Affiliated to Fujian Chinese Traditional Medicine University from January 2014 to December, aged 1-6 years old, were randomly divided into 3 groups with 30 cases in each: TAP beneath the rib edge in subcostal approach group, TAP from lateral abdomen wall in lateral approach group, and TAP from posterior wall in posterior approach group. The Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) and Ramsay sedation score were used to evaluate the analgesic and sedative effect. Analgesic plane, CHEOPS and Ramsay score were recorded at 4 h, 8 h, 12 h, 16 h and 24 h postoperatively. Nausea, vomit, skin itch, urinary retention, lower limb movement disorder, respiratory depression and other complications were observed and recorded. Results Compared with postoperative 4 h, CHEOPS increased in the subcostal approach group at 12 h after the operation, and increased in the lateral approach group at 16 h and the posterior approach group at 24 h, and Ramsay score decreased at the same time (P 0.05). The incidence of lower limb movement disorder in the subcostal approach group and the lateral approach group was lower compared with the posterior approach group (P<0.05). Conclusion Transversus abdominis plane block with three approaches can all relief the pain effectively in pediatric lower abdominal surgery within 8 h after operation, the effective analgesic time of subcostal approach TAP is shorter than others, and muscle strength of lower limbs is decreased in the posterior approach TAP. Lateral approach of TAP is the most suitable one for analgesic requirement after lower abdominal surgery in children. Key words: Transversus abdominis plane block; Pain,postoperative; Analgesia; Child; Puncture path