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Paediatric pain management has remained understated practice over a period of time. Recently ultrasound-guided (USG) guided techniques are gaining popularity for perioperative analgesia, especially in the paediatric population. So, the aim of the present study was to evaluate the efficacy of reduced dose ropivacaine-dexmedetomidine combination compared to standard 0.375% ropivacaine in USG guided transversus abdominis plane (TAP) block.Sixty children of either sex, aged 2-10 years, posted for elective open herniotomy under general anaesthesia were randomly divided into two groups of 30 patients each. Group RD received 0.2% ropivacaine with dexmedetomidine 1 mg kg 1 while group R received 0.375% ropivacaine at 0.5mL kg 1. Meantime to first rescue and total analgesics, Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) and Ramsay sedation score, haemodynamic parameters and adverse effects were noted.Time to first rescue analgesia in group RD and group R were 16.32 6 3.11 hours and 10.82 6 2.16 hours, respectively (P.0001). Mean CHEOPS score were 4.48 6 1.1 and 6.3 6 1.74 (P.024) in group RD and R. Post-op Ramsay sedation score was significantly greater in group RD. Heart rate and blood pressure remained similar in either of the group. No episode of respiratory depression, bradycardia or hypotension was noted perioperatively.Combination of 1 mg kg 1 dexmedetomidine with reduced concentration of ropivacaine (0.2%) produced significantly longer duration of post-operative analgesia and lowered post-operative CHEOPS pain score in comparison with 0.375% ropivacaine alone in USG guided TAP block for paediatric hernia repair.

Perioperative analgesia poses specific problems, especially when it comes to neonates and infants. The use of opioid in neonates is usually associated with the risk of delayed extubation and postoperative mechanical ventilation. Regional analgesia including epidural and caudal may be technically challenging or has limitations in a certain group of patients. Ultrasound (US)-guided transversus abdominis plane block (TAP) is gaining popularity as a new technique of regional anesthesia applicable to infants and children. Precise drug administration is a major concern with TAP blocks in pediatric patients, especially infants and neonates. The application of US has enhanced the accuracy of local anesthetic deposition and hence the efficacy of analgesia in TAP block. We, hereby, report a series of five high-risk infants and neonates posted for abdominal surgeries wherein an ultrasonography-guided TAP resulted in satisfactory perioperative analgesia obviating the need of systemic opioids.