Analgesia, Ultrasound Guided Block
Conditions
Keywords
Transverse abdominal plane bloc, pain, analgesia, ultrasound, children
Brief summary
The ilio-inguinal ilio-hypogastric (IIIH) nerve block remains the gold standard analgesic technique after inguinal surgery in children. Transverse abdominal plane (TAP) block has been reported to provide effective analgesia after lower abdominal surgery in adults. The aim of our study was to compare the analgesic effect of ultrasound-guided TAP block to IIIH nerve block after inguinal surgery in children.
Detailed description
The study aimed to compare the analgesic effect of ultrasound-guided transverse abdominal plane (TAP) block to ilio-inguinal ilio-hypogastric (IIIH) nerve block in children after inguinal surgery. This prospective, randomized study included children aged six months to twelve years, classified as ASA I or II, scheduled for elective unilateral inguinal surgery. Participants received either a TAP block or an IIIH block with bupivacaine following standardized induction of general anesthesia. Analgesics were not systematically administered post-induction. Postoperative pain was monitored for six hours in the hospital, and if the CHEOPS score exceeded 7, paracetamol was administered, with nalbuphine as a secondary option if needed. At home, parents assessed pain using the PPMP score, administering paracetamol and ibuprofen if necessary. Primary outcomes included postoperative analgesia quality, determined by time to first analgesic requirement and the need for analgesics at hospital and home. Secondary outcomes measured included block performance duration, parental satisfaction, and incidence of complications.
Interventions
PROCEDUREUltrasoud-guided TAP block
the ultrasound probe was placed at the mid-axillary line, and the needle was inserted into the space between the internal oblique and transverse muscles, splitting the inter-muscular fascia after injection of local anesthetic.
PROCEDUREUltrasound-guided Ilio-inguinal Ilio-Hypogatric block
the ultrasound probe was positioned transversely on the abdominal wall at the contact point of the anterosuperior iliac spine. The needle was inserted into the space between the internal oblique and transverse muscles, causing separation of the intermuscular fascia layers upon injection of the anesthetic mixture
Sponsors
Tunis University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Intervention model description
The patients were randomly assigned into two groups to receive after a standardized induction of general anesthesia either an ultrasound-guided TAP block or IIIH block with bupivacaine 0.3 ml/kg.
Eligibility
Sex/Gender
ALL
Age
6 Months to 12 Years
Healthy volunteers
No
Inclusion criteria
* Children aged 6 months to 12 years * ASA physical status 1 or 2 * Scheduled for unilateral inguinal surgery
Exclusion criteria
* Children scheduled for bilateral surgery or associated procedures (e.g., circumcision) * Parental refusal
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Quality of postoperative analgesia : PPMP score | 24 h after surgery | The quality of postoperative analgesia described by the pain score : Postoperative Pain Measure for Parents (PPMP) score, minimum value is 0 , maximum value 10 , a value higher than 6 indicates a major pain . |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Block execution time | From the beginning of the practice of the block to the end | — |
| Complications related to the techniques of nerve block | Perioperative | Complications related to local anesthetics or block technique such as hematoma, spread of local anesthetic to the femoral nerve, intraperitoneal injection ... |
Countries
Tunisia
Outcome results
None listed