Caudal block versus Ultrasound-guided transversus abdominis plane block for postoperative analgesia in children undergoing unilateral inguinal hernia surgery: A comparative study.

Introduction: Among regional anaesthetic techniques, Single shot caudal epidural block is the oldest and the most widely used technique with the drawback of short postoperative analgesia. Transversus Abdominis Plane (TAP) block under ultrasound guidance has been reported in recent studies as an easy and safe alternative to caudal block with added advantage of longer postoperative analgesia. Aim: This study was undertaken to compare the efficacy of the Ultrasound-guided TAP block with the Caudal epidural block in providing intra-operative and post-operative pain relief in children undergoing inguinal herniotomy. Materials and methods: Eighty children satisfying the inclusion criteria were included in the study. After obtaining informed consent from the parents/guardian of the patients, they were randomly allocated into two groups, Group T receiving USG-guided TAP Block with 0.5ml/kg of 0.25% bupivacaine and Group C receiving Caudal Epidural Block with 1ml/kg of 0.25% bupivacaine, with forty patients in each. Result: The duration of post-operative analgesia with TAP block group (517 mins) was significantly longer than Caudal block group (258 mins)(p value<0.05). The TAP block group had significant reduction in pain scores at 3, 4 and 5 hours postoperatively in comparison to Caudal group. The pain scores were lower in TAP block group compared to Caudal group at all observational times up to 24 hours after surgery. The mean analgesic requirement in the first 24 post-operative hours was significantly higher in Caudal group(396.75mg) when compared to TAP block group(217.1mg)(p value<0.05). Conclusion: Ultrasound-guided TAP block provided prolonged post-operative pain relief than single shot Caudal epidural block and reduced the mean analgesic consumption in the first 24 post-operative hours after inguinal herniotomy in children of age 1-6 years. Caudal epidural block provided better intra-operative analgesia than USG guided TAP block for inguinal hernia repair. [ABSTRACT FROM AUTHOR]