A prospective, randomized control study comparing ultrasound guided transversus abdominis plane block vs caudal epidural block for postoperative analgesia in children undergoing elective lower abdominal surgeries

INTRODUCTION: The term ‘pain’ is derived from the term ‘poena’ Pain is defined as “unpleasant emotional or sensory experience with associated potential or actual tissue damage or described in terms of such damage”. It is a proven fact all can receive pain regardless of age, neonates, infants, children, even a preterm child .They show a severe stress response to painful stimuli. AIM OF STUDY: This study compares the efficacy of ultrasound guided Transversus Abdominis Plane block and Caudal epidural block for post operative pain relief in children undergoing elective lower abdominal surgeries. MATERIALS AND METHODS: This study was a randomized prospective double blind study. This was conducted after getting approval of institutional ethical committee and written informed consent of parents (or) guardians. Sample Size Calculation In my pilot study it has been observed that there is a significant decrease in the total dose of postoperative oral acetaminophen (301.9 ± 161.26 vs. 635.05 ± 205.42 mg) (P = 0.00) in unilateral TAP block group compared to single caudal block group with a difference of 47%. Transversus Abdominis Plane Block has been reported to provide effective postoperative analgesia for lower abdominal surgeries. But there is not much data comparing Ultrasound guided Transversus Abdominis Plane Block with the Caudal Epidural Block, which is the most frequently used standard technique for pediatric lower abdominal surgeries. In this study we randomly selected 46 patients and divided in to two group. Group C received 1ml / kg of 0.25 % Bupivacaine Caudal block and Group T received Tap block using 0.3 ml / kg of 0.25 % Bupivacaine. The primary outcomes were the time to first analgesia in minutes and the analgesic doses required during the first 24 h postoperatively. The secondary outcome measures included FLACC pain scale score and intra operative hemodynamic variables. RESULTS: 1. Duration of analgesia was higher in TAP block group( 9hrs 44 minutes) compared to Caudal group (4 hours 5 minutes) which was statistically significant. 2. FLACC pain score for analgesic assessment were better in the TAP block group compared to Caudal group, which was statistically significant. 3. Post operative Heart rate, Post operative Diastolic and Mean arterial pressure were better in the TAP block group compared to Caudal group, which was statistically significant. 4. In both the groups, hemodynamic changes in intra operative period were comparable and insignificant. CONCLUSION: From my study, I conclude that administration of Ultrasound guided TAP BLOCK for children undergoing Lower Abdominal Surgeries increases the duration of post operative analgesia without producing any adverse effects compared to Caudal epidural block. Thus, ultra sound guided TAP block can be used for prolonging the post operative analgesic effect