Ultrasound-Guided Transverses Abdominis Plane Block versus Caudal Block for Postoperative Analgesia in Children Undergoing Inguinal Hernia Repair: A Randomized Controlled Trial

Abstract

Background: This prospective double-blind, randomized controlled study compared ultrasound-guided transverses abdominis plane block (UTAP) and caudal block (CB) in pediatric patients undergoing inguinal hernia repair. We hypothesized that UTAP, compared with CB, could provide non-inferior analgesia in the first 24 hours post anesthesia.Methods: A UTAP or CB was performed in patients as a component of multimodal analgesia. The time to use first rescue medication was estimated from intervention to 24 hours postoperatively as the primary outcome. The inferiority margin was -1 hour. If the lower limit of difference in the 95% confidence interval (CI) is greater than -1 hour, the non-inferiority is established. The secondary outcome included the number of patient not requiring rescue analgesia, the postoperative pain intensity, the incidence of emergence agitation, the residual motor block, the sedation score, and side effects.Results: One hundred enrolled patients were randomized and assigned (1:1) into either the UTAP group or the CB group. In the first 24 hours post anesthesia, the time of first rescue medication was 6.1 hours in the UTAP group and 6.2 hours in the CB group (adjusted difference -0.5 hour; 95% CI -0.90-0.78 hour, P=0.039). Compared with the UTAP group, patients in the CB had a higher incidence of residual motor block. There were no significant statistical differences in the number of patient not requiring rescue analgesia, the postoperative pain intensity, the incidence of emergence agitation, the sedation score, and side effects between the two groups.Conclusions: Compared with CB, the UTAP could provide non-inferior postoperative analgesia in the first 24 hours postoperatively. The UTAP is a safe and viable alternative in pediatric patients undergoing inguinal hernia repair. Citation: Yang Yang, Ying Lin, Yu-Sheng Yao, Yan-Qing Chen. Ultrasound-guided transverses abdominis plane block versus caudal block for postoperative analgesia in children undergoing inguinal hernia repair: a randomized controlled trial. J Anesth Perioper Med 2016; 3: 109-113. doi: 10.24015/JAPM.2016.0014This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.