Our Experiences with Caudal Epidural and Transversus Abdominis Plan (tap)

Block in Pediatric Patiens

Yeşim ANDIRAN ŞENAYLI1, Cevdet YARDIMCI1, Muhammed Nuri POLAT1, Sevgi ULUSOY TANGÜL2

1Bozok Üniversitesi Anesteziyoloji ve Reanimasyon 2Bozok Üniversitesi Çocuk Cerrahisi

Introduction - Purpose: Caudal block (CB) is achieved by administration of local anesthetics to epidural space via sacral hiatus. As a sole anesthesia method, caudal block has advantages of avoiding volatile anesthetics, neuromuscular blockers, analgesics. For Transversus Abdominis Plan (TAP) block, local anesthetic is administered to area defined as “transversus abdominis plane” between internal oblique muscle in anterolateral region of the abdomen and transversus abdominis muscle. It's been reported that both blocks provide effective intra&postoperative analgesia and reduce the need for additional analgesics. We discussed our caudal and TAP block managements on pediatric surgery patients in Yozgat Bozok University.

Materials and Methods: Caudal block and TAP block were performed between September 2021 -June 2023, 92 pediatric patients were evaluated retrospectively. The patients' age, gender, type of surgery, need for additional analgesics intra&postoperatively, causes of need additional analgesics were recorded. Postoperative pain levels of all patients were evaluated with FLACC&VAS scales.

Results: Of the patients aged 0-17 years, 9 (9.8%) were female, 83 (90.2%) were male. TAP was applied to 19 of them and caudal block to 73. Number of patients and their related cause of surgical interventions were as follows; 11patients-appendicitis,24patients-inguinal hernia,6patients- inguinal hernia+circumcision, 4patients-undescended testis,7patients-undescended testicle+circumcision,3patients-circumcision,1patient-testicular torsion,1patient-urachus malformation,1patient-urethral chord, 1patient-pilonidal sinus,1patient-vaginal atresia.In recovery unit, patients didn't need any additional analgesics.Although there wasn’t high pain score, it was observed that 10mg/kgivparacetamol was administered to 21 patients within thefirst 4 hours postoperatively at ward. All outpatient-surgery patients were discharged at postoperative 3rd hour without problem of oral intake and recovery. There were no unplanned, unexpectedly prolonged hospitalization.

Discussion - Conclusion: Caudal&TAP blocks, which are frequently used in surgical procedures of pediatric patients, were found to be effective in postoperative analgesia. It is accept that additional analgesics were used to relieve the restlessness/agitation rather than pain-relief especially by parents.

Keywords: Caudal Block, Pediatric Analgesis, Regional Anesthesia, Transversus Abdominis Plan Block, Pediatric Anesthesia