title: Comparison of caudal epidural block and ultrasonography-guided transversus abdominis plane block for pain relief in children undergoing lower abdominal surgery.
abstract: OBJECTIVE
  We conducted this study to compare the efficacy of caudal epidural block (CEB) vs ultrasonography-guided transversus abdominis plane (TAP) block for providing postoperative pain relief in children scheduled for lower abdominal surgery. Whereas the primary objective was to compare the duration of postoperative analgesia, the secondary objectives included comparative assessment (TAP vs CEB) of quality of pain relief in the first 24hours postoperatively and rescue analgesia requirements.
  
  
  METHODS
  Randomized-control, prospective, observer-blinded, 2-arm, single-center comparison.
  
  
  METHODS
  Operating room, postoperative recovery area.
  
  
  METHODS
  Eighty-children, aged 2-6years, of American Society of Anesthesiologists physical status I/II scheduled to undergo unilateral lower abdominal surgery under general anesthesia.
  
  
  METHODS
  The recruited children were randomly allocated to receive under general anesthesia either CEB (group C, 0.75 mL/kg of 0.25% bupivacaine) or ultrasonography-guided administration of TAP block (group T, 0.5 mL/kg of 0.25% bupivacaine).
  
  
  METHODS
  Intraoperative: heart rate and noninvasive blood pressure; postoperative: pain profile, including duration of postoperative analgesia, quality of pain relief, and rescue analgesia requirements.
  
  
  RESULTS
  The median duration of postoperative analgesia was significantly greater in children who received CEB than those who were administered TAP block (group C: 362.5 minutes [172.5-693.75] vs group T: 210 minutes [108.75-362.5]; P<.05). No difference was found in the incidence of postoperative pain up to 6 hours from the point of initiation of assessment (group C: 47.2% vs group T: 55.9%; P>.05). The children who received CEB experienced greater incidence of pain in the 6- to 24-hour postoperative interval than those administered TAP block (group C: 75% vs group T: 44.1%; P<.05). Although there was no difference in the rescue analgesia requirements, the number of children not requiring any rescue analgesia in the first 24 hours postoperatively was significantly higher in the TAP group (group C: n=2 vs group T: n=8; P<.05).
  
  
  CONCLUSIONS
  In children undergoing lower abdominal surgery, CEB provides a significantly prolonged duration of postoperative analgesia when compared with ultrasonography-guided TAP block.
authors.affiliation: Department of Anaesthesiology, Pain, & Perioperative Medicine. Electronic address: nitinsethi77@yahoo.co.in.
authors.forename: Nitin
authors.initials: N
authors.lastname: Sethi
authors.affiliation: Department of Anaesthesiology, Pain, & Perioperative Medicine.
authors.forename: Deepanjali
authors.initials: D
authors.lastname: Pant
authors.affiliation: Department of Anaesthesiology, Pain, & Perioperative Medicine.
authors.forename: Amitabh
authors.initials: A
authors.lastname: Dutta
authors.affiliation: Department of Anaesthesiology, Pain, & Perioperative Medicine.
authors.forename: Archna
authors.initials: A
authors.lastname: Koul
authors.affiliation: Department of Anaesthesiology, Pain, & Perioperative Medicine.
authors.forename: Jayashree
authors.initials: J
authors.lastname: Sood
authors.affiliation: Department of Research, Sir Ganga Ram Hospital, New Delhi, 110060, India.
authors.forename: Parul T
authors.initials: PT
authors.lastname: Chugh
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000009:Abdominal Muscles / Q000000981:diagnostic imaging*; D000763:Anesthesia, Caudal / Q000379:methods*; D000768:Anesthesia, General; D001794:Blood Pressure / Q000187:drug effects; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007223:Infant; D008297:Male; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000628:therapy*; D011446:Prospective Studies; D018084:Ultrasonography, Interventional
keywords: Analgesia; Caudal; Transversus abdominis plane; Ultrasonography