Transversus abdominis plane block versus caudal block with bupivacaine and dexmedetomidine for unilateral inguinal hernia repair in pediatric patients: a randomized clinical trial

BACKGROUND: This study compared the transversus abdominis plane (TAP) block with bupivacaine and dexmedeto-midine to the same mixture in the caudal block in delivering postoperative analgesia in children after unilateral inguinal hernia surgery. METHODS: The current study included 80 children aged two to eight years who were scheduled for unilateral inguinal hernia surgery under general anesthesia. A caudal block (1 mL/kg 0.25% bupivacaine and one mu g /kg dexmedetomidine) or a TAP block (1 mL/kg 0.25% bupivacaine and one mu g /kg dexmedetomidine) was given to each participant at random. The time it took to request analgesia for the first time, the postoperative pain score, total analgesic use, sedation, family satisfaction, and side effects were all measured. The primary outcome was time to first analgesic request. RESULTS: The caudal block group had a considerably shorter time to first analgesic request than the TAP block group. The caudal block group received more rescue analgesia doses within 24 hours than the TAP block group. The mean total dose of intravenous paracetamol within the first 24 hours postoperatively was greater in the caudal block group. The caudal block group had much higher family satisfaction. CONCLUSIONS: The TAP block and caudal block provide good postoperative analgesia in children undergoing uni-lateral inguinal hernia repair. Adding dexmedetomidine to the TAP block was superior to the caudal block in terms of extending the length of the initial analgesic request, lowering analgesic requirement, and lowering pain scores without causing substantial adverse effects.