Key result
TAP and ilioinguinal/iliohypogastric blocks significantly decreased intraoperative sevoflurane usage (P<0.001) and prolonged analgesia duration (P<0.001) compared to sevoflurane alone.
Why the study?
Do TAP or II/IH blocks combined with sedation reduce intraoperative Sevoflurane usage and improve postoperative analgesia in pediatric patients undergoing lower abdominal surgery compared to Sevoflurane alone?
RCT (n=100)
randomized
Do TAP or II/IH blocks combined with sedation reduce intraoperative Sevoflurane usage and improve postoperative analgesia in pediatric patients undergoing lower abdominal surgery compared to Sevoflurane alone?
p-value: p=<0.001
TAP and II/IH blocks provide similar intraoperative and postoperative hemodynamic stability and analgesia in pediatric lower abdominal surgery, significantly reducing the need for Sevoflurane.
Supports adding TAP/II/IH blocks to sedation for pediatric lower abdominal surgery to reduce sevoflurane; confirms efficacy for intraoperative sparing and prolonged analgesia.
Background: Regional techniques both reduce opioid requirements and provide quality pain control in patients, especially in pediatrics. Objectives: The aim of this study was to compare the contributions of ilioinguinal/iliohypogastric (II/IH) block and transversus abdominis plane (TAP) block combined with sedation to intraoperative anesthesia and analgesia in pediatric surgery. Methods: In this randomized controlled study, 100 patients aged 2 - 6 years were enrolled and divided into five groups: TAP block with ketamine; II/IH block with ketamine; TAP block with Sevoflurane; II/IH block with Sevoflurane; and the control group with Sevoflurane alone. Hemodynamics (mean arterial pressure (MAP) and heart rate (HR)), depth of anesthesia, Sevoflurane usage, pain score, number of children who needed analgesia, and the time to start rescue analgesia of all patients were recorded. Results: There was no significant difference between the study groups, in HR and MAP during operations (P > 0.05). The amount of Sevoflurane used in the group supported with both blocks decreased significantly compared to the control group (P < 0.001). In the groups where the block was added until the 6th hour in the postoperative period, there were lower HR and MAP (P < 0.05). Pain scores were high in the first six hours in the control group (P < 0.05). There was a longer duration of analgesia in the ketamine + TAP group and the Ketamine + II/IH block group (P < 0.001) in comparison to others. A higher analgesic need was found in the control group (P < 0.05). Conclusions: This study revealed that transversus abdominis plane or ilioinguinal/iliohypogastric regional blocks could have same intraoperative/ postoperative effects regarding hemodynamics and intraoperative analgesia in lower abdominal pediatric surgery. Anesthesia can be maintained using sedative medicines only.
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Küpeli et al. (2018) conducted an RCT in pediatric surgery (n=100). Transversus abdominis plane (TAP) block or ilioinguinal/iliohypogastric (II/IH) block vs. Sevoflurane alone was evaluated on Intraoperative anesthesia and analgesia (hemodynamics, Sevoflurane usage, pain scores, analgesic need) (p=<0.001). TAP and ilioinguinal/iliohypogastric blocks significantly decreased intraoperative sevoflurane usage (P<0.001) and prolonged analgesia duration (P<0.001) compared to sevoflurane alone.
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