Transversus abdominis plane block versus caudal block for postoperative pain control after day-case unilateral lower abdominal surgeries in children: a prospective, randomized study

Abstract

Background The transversus abdominis plane (TAP) block is a relatively simple technique that may prove useful in the management of postoperative pain. It decreases the amount of intraoperative and postoperative opioid requirements after surgery. Caudal block is a gold standard technique in pediatric surgeries.Patients and methods Seventy-five children aged 1–7 years with ASA I or II scheduled for day-case unilateral lower abdominal surgeries were randomly allocated to two groups: group C (caudal block) and group T (TAP block). Group C received caudal 0.25% bupivacaine at 1 ml/kg and group T received 0.25% bupivacaine at 1 ml/kg. Time to first analgesic request, total intraoperative fentanyl consumption, postoperative tramadol requirement, sedation level, parent satisfaction scores, pain score, postanesthetic care unit time and day-surgery unit time, and side effects were reported.Results The two groups were comparable in terms of total intraoperative fentanyl consumed, postoperative tramadol requirement, postoperative pain scores, time to first administration of rescue analgesia, and postanesthetic care unit time. Children in the TAP group were discharged home significantly earlier than those in the caudal group (306.8 ± 18 vs. 259 ± 22.4 min with P < 0.001). More children in the caudal group experienced vomiting when compared with the other group. Parent satisfaction score was statistically significantly higher in the TAP group when compared with the caudal group [80 (70–90) vs. 95 (80–95) with P < 0.001].Conclusion TAP block and caudal block provided adequate relief from postoperative pain after day-case unilateral lower abdominal surgeries in children. However, TAP block resulted in better parent satisfaction and earlier home discharge with fewer side effects when compared with caudal block.