Comparative Study between Ultrasound Guided TransversusAbdominis Nerve Block and Caudal Epidural Anesthesia in pediatric patients undergoing lower Abdominal Surgery.

Abstract

Postoperative pain is a major cause of adverse effects in many organ systems thus anterior abdominal wall analgesia after abdominal surgery may assist in improving postoperative outcome. The analgesic regimen needs to meet the goals of providing safe, effective analgesia, with minimal side effects for the patient, together with inhibition of trauma –induced nociceptive impulses. Many studies have been carried out trying to find a solution for these dilemma thus different pain modalities as local infiltration of the surgical field, systemic analgesia (narcotics and non-narcotics), neuro-axial blocks, and nerve blocks shined out, however each has shown its side effect which limits its use to specific cases. Caudal anesthesia is the most frequently used regional technique in children; accounting for almost 50%of all regional techniques. Although the caudal remains the most commonly usedregional anesthetic technique in infants and children, ithas been demonstrated that effective analgesia can be provided with the use of peripheral nerve blockadeeven in the pediatric-aged patient. Abdominal field blocks have been extensively used for a variety of surgical procedures for many years. They are simple to perform and have a good safety profile. Until recently, there has been renewed interest in abdominal field blocks and the quest for a single injection providing widespread analgesia has lead to the rapid popularity of the Transversus Abdominis Plane (TAP) block. The description of a landmark technique for performing a TAP block advocated a single entry point, the triangle of Petit, to access a number of abdominal wall nerves hence providing multi-­dermatome analgesia.