Ultrasound (US) guided transversus abdominis plane (TAP) block for paediatric inguinal hernia surgery – a pilot study

Abstract

Aim: To assess the effectiveness of ultrasound guided TAP block compared to ilioinguinal block for inguinal hernia surgery.Background: The transversus abdominis plane block has been shown to provide effective intra‐ and postoperative analgesia following lower abdominal surgery [1‐3] and may be an acceptable alternative to the ilioinguinal block in the setting of inguinal surgery [4,5]. It has been suggested that the TAP block is easier to perform than the ilioinguinal block, while also facilitating in‐plane needle imaging [4].Methods: Subjects scheduled for inguinal hernia surgery were prospectively randomized to US guided ilioinguinal or TAP block using a total volume of 0.3 ml kg‐1 of 50 : 50 lignocaine 1%/ ropivacaine 1%. A single operator experienced in US guided regional anaesthesia performed all blocks. Muscle images were graded on a 4‐point scale (vivid or barely visible, 2 or 3 muscles). Surgery commenced 5 mins following block placement. Fentanyl 0.25 mcg kg‐1 was given PRN during surgery for an increase in heart rate, mean arterial pressure or respiratory rate >20% from postinduction values. Intravenous morphine was given in the PACU for nurse‐assessed moderate to severe pain or emergence agitation. Ibuprofen was given at home for parent‐assessed pain nonresponsive to paracetamol. Blinded observers assessed age appropriate pain score (0–10) in the PACU, day stay unit and during the first 24 h. Results Ilioinguinal TAP n 12 8 Images: ‘vivid + 3 muscles’ (n%) 58 100 Block time, s (mean) 91 48 Intraoperative fentanyl (n%) 66 63 Worst PACU pain score (median) 2.5 0 PACU morphine required (n%) 17 25 Worst day stay unit pain score (median) 1 5 Doses paracetamol/ibuprofen /24 he (mean) 2.2/0.4 1.5/0.8 Conclusions: Interim results support ongoing evaluation of the TAP block for inguinal hernia surgery.References1 Shibata Y, Sato Y, Fujiwara Y, Komatsu T. Transversus abdominis plane block. Anesth Analg 2007; 105: 883; author reply 883.2 McDonnell JG, O’Donnell B, Curley G, Heffernan A, Power C, Life JG. The analgesic efficacy of transversus abdominis plane block after abdominal surgery: a prospective randomized controlled trial. Anesth Analg 2007; 104: 193–197.3 Hubbard P, Fujiwara Y, Shibata Y, Royse C. Ultrasound‐guided transversus abdominis plane (TAP) block. Anaesth Intensive Care 2007; 35: 616–6174 Fredrickson MJ. Early experience with the transversus abdominis plane block in children. Pediatric Anesthesia 2008; 18: 891.5 Banal V. The efficacy of transversus abdominis plane after inguinal surgery. http://www.asra.com/abstracts/spring2008: A59 2008.