Anesthesia, Recovery Period
Conditions
Keywords
Transversus Abdominis Plane Block, Caudal Epidural, Pediatric Pain control, Pain control for Lower Abdominal Surgery
Brief summary
Transversus abdominis plane block (TAPB) has emerged as a safe and effective regional anesthesia technique for providing postoperative lower abdominal analgesia. Complications associated with TAPB are very rare and pose a lower overall risk to the patient receiving a TAPB versus a caudal block, which is considered the gold standard for pediatric lower abdominal regional anesthesia. Our study hypothesis was that TAPB would be equivalent to caudal block initially in providing postoperative pain control but would show improved pain relief beyond the anticipated caudal duration.
Detailed description
The study design was a double-blinded randomized controlled trial. A minimum of 44 children between the ages of 1 and 9 undergoing bilateral ureteral reimplantation surgery through a low transverse incision will be enrolled. Narcotic requirement, pain scores (FLACC/FACES), episodes of nausea/vomiting, and anti-spasmodic requirement will be recorded in the PACU and at 6 hour intervals through 24 hours from the time of the block placement.
Interventions
PROCEDURECaudal Epidural
Ultrasound Guided Caudal Block
PROCEDURETransversus Abdominis Plane Block
Ultrasound Guided Transversus Abdominis Plane Block
Sponsors
Nemours Children's Clinic
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
TRIPLE (Subject, Caregiver, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
1 Years to 9 Years
Healthy volunteers
No
Inclusion criteria
* Patients aged 1 to 9 years old scheduled for intravesicular ureteral reimplantation surgery
Exclusion criteria
1. Coagulation status or anatomic variations precluded safe placement of either TAPB or caudal epidural, 2. there was a preexisting chronic pain disorder, 3. there was a history of constipation that persisted despite appropriate treatment and that may have impacted postoperative pain assessments, 4. additional procedures were planned via a separate incision at the time of the ureteral reimplantation, 5) there was a contraindication to receiving the medications described in the protocol.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Narcotic requirement | 24 hours post intervention | Narcotic requirement was recorded at 24 hours from the time of the block placement. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| episodes of nausea/vomiting | 24 hours | Episodes of nausea/vomiting were recorded at 24 hours from the time of the block placement. |
| anti-spasmodic requirement | 24 hours post intervention | Anti-spasmodic requirement were recorded at 24 hours from the time of the block placement. |
| Pain Scores | 24 hours post intervention | Pain scores (FLACC/FACES) were recorded at 24 hours from the time of the block placement |
Countries
United States
Outcome results
None listed