The prospective, randomization of the effects of the bilateral transversus abdominis plan block and the postoperative analysis of the kaudal block on the lower abdomen surgery of pediatric patients

AİM: The hypothesis of this study is to show that bilateral transversus abdominis plan (TAP) block will be as effective as caudal block in early postoperative analgesia and the duration of action will be longer than the caudal block. Our primary outcomes are FLACC (face, legs, activity, cry, consolability) and visuel analog score (VAS) scores in the first 48 hours, secondary outcomes are postoperative opioid consumption, need for additional analgesics, complications, family satisfaction and chronic pain development. MATERIALS AND METHODS: Sixty patients aged 1-12 years undergoing lower abdominal surgery (bilateral inguinal hernia) were included in this prospective, randomized, double-blind study. Patients were randomized between two groups. Patients and practitioners (HP, BD) who examine postoperative pain score were blinded to the study groups. Electrocardiogram (ECG), pulse oximetry (SPO2) and noninvasive blood pressure (NİBP) monitoring were performed to the patients who were taken to the operation room. Following anesthesia induction and intubation, TAP block (Group T) was applied to the other group and caudal block (Group K) was applied to the other group. Patients in both groups received 0.25% bupivacaine 1mg/kg. The response to the surgical incision was checked and fentanyl 1 mcg/kg iv was applied to the patients whose increased heart rate (HR) more than 20%. Before induction, during induction, in surgical incision and intraoperative period, 15th,30th,45th,60th minutes HR, systolic and diastolic arterial pressure (SAP and DAP), end-tidal CO2 (ETCO2) and respiratory rate (RR) were recorded (Appendix 1). In the postoperative period, the VAC values with FLACC scale were recorded as 15th,30th,45th minutes and 1th,2th,6th,12th,24th and 48th hour (Appendix-2). In patients with FLACC≥3 and / or VAS≥4, tramadol 1 mg/kg administered intravenously (iv) and was recorded as a need for additional analgesia. At the same time intervals, the patients were recorded for KTA, mean arterial pressures (MAP), RR. In addition, the patients' complaints of nausea, vomiting, complications such as hematoma, infection and family satisfaction were recorded. The patients who were discharged were contacted by telephone and 48th hour pain scores and chronic pain were examined (Appendix2). 9 RESULTS: There was no statistically significant difference between the groups in terms of demographic data (p>0.05). There was no statistically significant difference between the groups in terms of intraoperative 15th,30th,45th,60th minutes HR, SAP, DAP, SPO2 and ETCO2 during induction, during surgical incision (p> 0.05). When VAS and FLACC scores were compared in the postoperative period, there was no statistically significant difference between 15th,30th,45th,60th minutes, 1st,12th hour in Group K and Group T (p>0.05). 2th hour VAS score, 6th,24th hour FLACC and VAS scores were significantly lower in Group T than Group K (p<0.05). Postoperative analgesic requirement was significantly lower in Group T compared to Group K (p<0.05). No significant difference was found between in Group T and Group K in terms of nausea and vomiting (p>0.05). None of the patients in Group K and Group T had chronic pain in the postoperative period and no complication was observed. Patients in Group T was discharged earlier than Grup K (p<0.05). (Table 2) CONCLUSION: In our study, TAP block was effective as a caudal block which was accepted as the gold standard in children. In addition, we think that application of TAP block may be a good option in bilateral inguinal hernia operations as part of multimodal analgesia in children in order to provide advantages such as low need for additional analgesia and shorter hospital stay compared to caudal block.