Comparison between Ultrasound-Guided Transversus Abdominis Plane Block and Ultrasound-Guided Erector Spinae Plane Block During Pediatric Laparoscopic Surgeries: A Randomized, Controlled, Prospective Study
Main Article Content
Keywords
Ultrasound-Guided Transversus Abdominis Plane Block, Ultrasound-Guided Erector Spinae Plane Block, Pediatric, Laparoscopic Surgeries
Abstract
Background: Pain after laparoscopic surgeries is caused by the incision and viscero-peritoneal pain due to peritoneal stretch and inflammation. Neonates and infants have increased sensitivity to narcotics. Ultrasound-guided erector spinae plane block (USG-ESPB) is a novel technique reported to have analgesic effect on somatic and visceral pain. We aimed to compare ultrasound guided TAPB (USG-TAPB) with USG-ESPB in providing peri-operative analgesia in pediatric participants undergoing laparoscopic surgeries.
Methods: This single blinded, prospective, randomized controlled study was carried out on 84 participants aged from 2 months to 7 years old, scheduled for elective general laparoscopic surgeries. Participants were randomly allocated into two groups to receive either intraoperative ESPB and intravenous fentanyl (42 participant) or intraoperative TAPB and intravenous fentanyl (42 participant), and then further classified in to child and infant groups.
Results: FLACC score was lower in the ESPB in (infant and child) with significance in the 4th, 8th and 12th hour assessment in infant and child group (P ≤ 0.05). The time to first postoperative analgesic requirement was significantly longer in the ESPB than in the TAPB (P < 0.001).
Conclusions: When performing laparoscopic procedures on minors, ESPB proved to be an effective localized anesthetic method. ESPB had a more analgesic character than TAPB because its participants experienced extended block durations and less pain in the immediate postoperative phase.
References
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11. Kehlet H, Holte K. Effect of postoperative analgesia on surgical outcome. Br J Anaesth. 2001;87:62-72.
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17. Ahmed A. Laparoscopic surgery in children--anaesthetic considerations. J Pak Med Assoc. 2006;56:75-9.
18. Abdulatif M, Mukhtar A, Obayah G. Pitfalls in reporting sample size calculation in randomized controlled trials published in leading anaesthesia journals: a systematic review. Br J Anaesth. 2015;115:699-707.
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24. Ueshima H, Inagaki M, Toyone T, Otake H. Efficacy of the Erector Spinae Plane Block for Lumbar Spinal Surgery: A Retrospective Study. Asian Spine J. 2019;13:254-7.
25. Gürkan Y, Aksu C, Kuş A, Yörükoğlu UH, Kılıç CT. Ultrasound guided erector spinae plane block reduces postoperative opioid consumption following breast surgery: A randomized controlled study. J Clin Anesth. 2018;50:65-8.
26. Altıparmak B, Korkmaz Toker M, Uysal A, Turan M, Gümüş Demirbilek S. Comparison of the effects of modified pectoral nerve block and erector spinae plane block on postoperative opioid consumption and pain scores of participants after radical mastectomy surgery: A prospective, randomized, controlled trial. J Clin Anesth. 2019;54:61-5.
27. Urigel S, Molter J. Transversus abdominis plane (TAP) blocks. Aana J. 2014;82:73-9.
28. Malawat A, Verma K, Jethava D, Jethava DD. Erector spinae plane block and transversus abdominis plane block for postoperative analgesia in cesarean section: A prospective randomized comparative study. J Anaesthesiol Clin Pharmacol. 2020;36:201-6.
29. Luis-Navarro JC, Seda-Guzmán M, Luis-Moreno C, Chin KJ. Erector spinae plane block in abdominal surgery: Case series. Indian J Anaesth. 2018;62:549-54.
30. Ahiskalioglu A, Tulgar S, Celik M, Ozer Z, Alici HA, Aydin ME. Lumbar Erector Spinae Plane Block as a Main Anesthetic Method for Hip Surgery in High Risk Elderly Participants: Initial Experience with a Magnetic Resonance Imaging. Eurasian J Med. 2020;52:16-20.
31. Chatrath V, Khetarpal R, Kumari H, Kaur H, Sharma A. Intermittent Transcutaneous Electrical Nerve Stimulation versus Transversus Abdominis Plane Block for Postoperative Analgesia after Infraumbilical Surgeries. Anesth Essays Res. 2018;12:349-54.
32. Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T, et al. Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain. 2016;17:131-57.
33. Basaran B, Basaran A, Kozanhan B, Kasdogan E, Eryilmaz MA, Ozmen S. Analgesia and respiratory function after laparoscopic cholecystectomy in participants receiving ultrasound-guided bilateral oblique subcostal transversus abdominis plane block: a randomized double-blind study. Med Sci Monit. 2015;21:1304-12.
34. Ma J, Jiang Y, Tang S, Wang B, Lian Q, Xie Z, et al. Analgesic efficacy of ultrasound-guided subcostal transversus abdominis plane block. Medicine (Baltimore). 2017;96:e6309.
35. Khalil MMH. Ultrasound-guided rectus sheath block for pediatric participants undergoing elective abdominal midline operations: a randomized controlled trial. Ain Shams J Anesthesiol. 2016;9:403-8.
36. Aksu C, Gürkan Y. Ultrasound guided erector spinae block for postoperative analgesia in pediatric nephrectomy surgeries. J Clin Anesth. 2018;45:35-6.
37. Al-Sadek WM, Rizk SN, Selim MA. Ultrasound guided transversus abdominis plane block in pediatric participants undergoing laparoscopic surgery. Egypt J Anaesth. 2014;30:273-8.
38. Al-Sadek WM, Rizk SN, Selim MA. Ultrasound guided transversus abdominis plane block in pediatric participants undergoing laparoscopic surgery. Egyptian Journal of Anaesthesia. 2014;30:273-8.
2. Fredrickson MJ, Seal P. Ultrasound-guided transversus abdominis plane block for neonatal abdominal surgery. Anaesth Intensive Care. 2009;37:469-72.
3. Coté CJ, Karl HW, Notterman DA, Weinberg JA, McCloskey C. Adverse sedation events in pediatrics: analysis of medications used for sedation. Pediatrics. 2000;106:633-44.
4. Gupta R, Singh S. Challenges in paediatric laparoscopic surgeries. Indian J Anaesth. 2009;53:560-6.
5. EYu D, Gusev A, Bekin A, Romanova E. Laporoscopic Surgery as the Gold Standard for the Treatment of Inguinal Hernia in Children. Pediatric Pharmacology. 2018;15:90-4.
6. Barczyński M, Herman RM. A prospective randomized trial on comparison of low-pressure (LP) and standard-pressure (SP) pneumoperitoneum for laparoscopic cholecystectomy. Surg Endosc Other Interv Tech. 2003;17:533-8.
7. Ekstein P, Szold A, Sagie B, Werbin N, Klausner JM, Weinbroum AA. Laparoscopic surgery may be associated with severe pain and high analgesia requirements in the immediate postoperative period. Ann Surg. 2006;243:41-6.
8. Yu N, Long X, Lujan-Hernandez JR, Succar J, Xin X, Wang X. Transversus abdominis-plane block versus local anesthetic wound infiltration in lower abdominal surgery: a systematic review and meta-analysis of randomized controlled trials. BMC Anesthesiol. 2014;14:121.
9. Sandeman DJ, Bennett M, Dilley AV, Perczuk A, Lim S, Kelly KJ. Ultrasound-guided transversus abdominis plane blocks for laparoscopic appendicectomy in children: a prospective randomized trial. Br J Anaesth. 2011;106:882-6.
10. Chin KJ, Adhikary S, Sarwani N, Forero M. The analgesic efficacy of pre-operative bilateral erector spinae plane (ESP) blocks in participants having ventral hernia repair. Anaesthesia. 2017;72:452-60.
11. Kehlet H, Holte K. Effect of postoperative analgesia on surgical outcome. Br J Anaesth. 2001;87:62-72.
12. Capdevila X, Barthelet Y, Biboulet P, Ryckwaert Y, Rubenovitch J, d'Athis F. Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after major knee surgery. Anesthesiology. 1999;91:8-15.
13. Mitra S, Khandelwal P, Roberts K, Kumar S, Vadivelu N. Pain relief in laparoscopic cholecystectomy--a review of the current options. Pain Pract. 2012;12:485-96.
14. Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The Erector Spinae Plane Block: A Novel Analgesic Technique in Thoracic Neuropathic Pain. Reg Anesth Pain Med. 2016;41:621-7.
15. Chin KJ, Malhas L, Perlas A. The Erector Spinae Plane Block Provides Visceral Abdominal Analgesia in Bariatric Surgery: A Report of 3 Cases. Reg Anesth Pain Med. 2017;42:372-6.
16. Nishant K, Bhattarai B, Adhikary S. Anaesthetic management for laparoscopic cholecystectomy in a child. J Soc Anesthesiol Nepal. 2014;1:83-5.
17. Ahmed A. Laparoscopic surgery in children--anaesthetic considerations. J Pak Med Assoc. 2006;56:75-9.
18. Abdulatif M, Mukhtar A, Obayah G. Pitfalls in reporting sample size calculation in randomized controlled trials published in leading anaesthesia journals: a systematic review. Br J Anaesth. 2015;115:699-707.
19. Lejus C, Surbled M, Schwoerer D, Renaudin M, Guillaud C, Berard L, et al. Postoperative epidural analgesia with bupivacaine and fentanyl: hourly pain assessment in 348 paediatric cases. Paediatr Anaesth. 2001;11:327-32.
20. Tulgar S, Kapakli MS, Senturk O, Selvi O, Serifsoy TE, Ozer Z. Evaluation of ultrasound-guided erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: A prospective, randomized, controlled clinical trial. J Clin Anesth. 2018;49:101-6.
21. Forero M, Rajarathinam M, Adhikary S, Chin KJ. Erector spinae plane (ESP) block in the management of post thoracotomy pain syndrome: A case series. Scand J Pain. 2017;17:325-9.
22. Halabi WJ, Kang CY, Nguyen VQ, Carmichael JC, Mills S, Stamos MJ, et al. Epidural analgesia in laparoscopic colorectal surgery: a nationwide analysis of use and outcomes. JAMA Surg. 2014;149:130-6.
23. El-Boghdadly K, Pawa A. The erector spinae plane block: plane and simple. Anaesthesia. 2017;72:434-8.
24. Ueshima H, Inagaki M, Toyone T, Otake H. Efficacy of the Erector Spinae Plane Block for Lumbar Spinal Surgery: A Retrospective Study. Asian Spine J. 2019;13:254-7.
25. Gürkan Y, Aksu C, Kuş A, Yörükoğlu UH, Kılıç CT. Ultrasound guided erector spinae plane block reduces postoperative opioid consumption following breast surgery: A randomized controlled study. J Clin Anesth. 2018;50:65-8.
26. Altıparmak B, Korkmaz Toker M, Uysal A, Turan M, Gümüş Demirbilek S. Comparison of the effects of modified pectoral nerve block and erector spinae plane block on postoperative opioid consumption and pain scores of participants after radical mastectomy surgery: A prospective, randomized, controlled trial. J Clin Anesth. 2019;54:61-5.
27. Urigel S, Molter J. Transversus abdominis plane (TAP) blocks. Aana J. 2014;82:73-9.
28. Malawat A, Verma K, Jethava D, Jethava DD. Erector spinae plane block and transversus abdominis plane block for postoperative analgesia in cesarean section: A prospective randomized comparative study. J Anaesthesiol Clin Pharmacol. 2020;36:201-6.
29. Luis-Navarro JC, Seda-Guzmán M, Luis-Moreno C, Chin KJ. Erector spinae plane block in abdominal surgery: Case series. Indian J Anaesth. 2018;62:549-54.
30. Ahiskalioglu A, Tulgar S, Celik M, Ozer Z, Alici HA, Aydin ME. Lumbar Erector Spinae Plane Block as a Main Anesthetic Method for Hip Surgery in High Risk Elderly Participants: Initial Experience with a Magnetic Resonance Imaging. Eurasian J Med. 2020;52:16-20.
31. Chatrath V, Khetarpal R, Kumari H, Kaur H, Sharma A. Intermittent Transcutaneous Electrical Nerve Stimulation versus Transversus Abdominis Plane Block for Postoperative Analgesia after Infraumbilical Surgeries. Anesth Essays Res. 2018;12:349-54.
32. Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T, et al. Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain. 2016;17:131-57.
33. Basaran B, Basaran A, Kozanhan B, Kasdogan E, Eryilmaz MA, Ozmen S. Analgesia and respiratory function after laparoscopic cholecystectomy in participants receiving ultrasound-guided bilateral oblique subcostal transversus abdominis plane block: a randomized double-blind study. Med Sci Monit. 2015;21:1304-12.
34. Ma J, Jiang Y, Tang S, Wang B, Lian Q, Xie Z, et al. Analgesic efficacy of ultrasound-guided subcostal transversus abdominis plane block. Medicine (Baltimore). 2017;96:e6309.
35. Khalil MMH. Ultrasound-guided rectus sheath block for pediatric participants undergoing elective abdominal midline operations: a randomized controlled trial. Ain Shams J Anesthesiol. 2016;9:403-8.
36. Aksu C, Gürkan Y. Ultrasound guided erector spinae block for postoperative analgesia in pediatric nephrectomy surgeries. J Clin Anesth. 2018;45:35-6.
37. Al-Sadek WM, Rizk SN, Selim MA. Ultrasound guided transversus abdominis plane block in pediatric participants undergoing laparoscopic surgery. Egypt J Anaesth. 2014;30:273-8.
38. Al-Sadek WM, Rizk SN, Selim MA. Ultrasound guided transversus abdominis plane block in pediatric participants undergoing laparoscopic surgery. Egyptian Journal of Anaesthesia. 2014;30:273-8.
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Published
Apr 15, 2023
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Amira Gamal Abd Elgaleel, Ahmed Hussein Sayed, Ramy Mohamed Elkoniessy, Mohamed Elayashy Mohamed, & Maha Gamil Hanna. (2023). Comparison between Ultrasound-Guided Transversus Abdominis Plane Block and Ultrasound-Guided Erector Spinae Plane Block During Pediatric Laparoscopic Surgeries: A Randomized, Controlled, Prospective Study. Journal of Population Therapeutics and Clinical Pharmacology, 30(7), 18–29. https://doi.org/10.47750/jptcp.2023.30.07.004
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