Ultrasound-guided transversus abdominis plane block in children A randomised comparison with wound infiltration

CONTEXTThe transversus abdominis plane (TAP) block is a new regional anaesthesia technique applicable to infants and children.OBJECTIVE(S)The present study was designed to evaluate the analgesic efficacy of ultrasound-guided TAP block with high volume local anaesthetic (0.5mlkg(-1)) during the first 24h after surgery in children undergoing inguinal hernia repair.DESIGNRandomised comparative study.SETTINGGaziantep University Hospital between December 2010 and May 2011.PATIENTS OR OTHER PARTICIPANTSFifty-seven children between 2 and 8 years of age undergoing unilateral inguinal hernia repair were randomised to TAP block (group T, n=29) or to wound infiltration (groupC, n=28).INTERVENTION(S)A TAP block using ultrasound guidance with 0.25% levobupivacaine 0.5mlkg(-1) or wound infiltration with 0.2mlkg(-1) 0.25% levobupivacaine, was performed on the same side as the hernia under general anaesthesia.MAIN OUTCOME MEASURESTime to first analgesic, cumulative number of doses of analgesic, pain scores and adverse effects were assessed over the course of 24h.RESULTSThe time to first analgesic (meanSD) was significantly longer in group T than in group C (176.8 vs. 4.7 +/- 1.6h, respectively; P<0.001). Thirteen (45%) patients in group T did not require any analgesic within the first 24h. The cumulative number of doses of analgesic was significantly lower in group T than in group C (1.3 +/- 1.2 vs. 3.6 +/- 0.7, respectively, P<0.001). Pain scores were significantly different between the groups at all time points except at 1, 20 and 24h (P<0.001).CONCLUSIONUltrasound-guided TAP block with high volume (0.5mlkg(-1)) 0.25% levobupivacaine provides prolonged postoperative analgesia and reduced analgesic use without any clinical side-effects after unilateral hernia repair in children.