TAPB vs. Caudal for Lower Abdominal Surgery in Children: A Double-Blinded Randomized Controlled Trial
Study Details
Study Description
Brief Summary
Transversus abdominis plane block (TAPB) has emerged as a safe and effective regional anesthesia technique for providing postoperative lower abdominal analgesia. Complications associated with TAPB are very rare and pose a lower overall risk to the patient receiving a TAPB versus a caudal block, which is considered the gold standard for pediatric lower abdominal regional anesthesia. Our study hypothesis was that TAPB would be equivalent to caudal block initially in providing postoperative pain control but would show improved pain relief beyond the anticipated caudal duration.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
Phase 4 |
Detailed Description
The study design was a double-blinded randomized controlled trial. A minimum of 44 children between the ages of 1 and 9 undergoing bilateral ureteral reimplantation surgery through a low transverse incision will be enrolled. Narcotic requirement, pain scores (FLACC/FACES), episodes of nausea/vomiting, and anti-spasmodic requirement will be recorded in the PACU and at 6 hour intervals through 24 hours from the time of the block placement.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Transversus Abdominis Plane Block Transversus Abdominis Plane Block TAPB Ultrasound guided TAPB |
Procedure: Transversus Abdominis Plane Block
Ultrasound Guided Transversus Abdominis Plane Block
|
| Experimental: Caudal Epidural Block Caudal Epidural Block Caudal Block Neuraxial Block Ultrasound Guided Caudal Block |
Procedure: Caudal Epidural
Ultrasound Guided Caudal Block
|
Outcome Measures
Primary Outcome Measures
- Narcotic requirement [24 hours post intervention]
Narcotic requirement was recorded at 24 hours from the time of the block placement.
Secondary Outcome Measures
- episodes of nausea/vomiting [24 hours]
Episodes of nausea/vomiting were recorded at 24 hours from the time of the block placement.
- anti-spasmodic requirement [24 hours post intervention]
Anti-spasmodic requirement were recorded at 24 hours from the time of the block placement.
- Pain Scores [24 hours post intervention]
Pain scores (FLACC/FACES) were recorded at 24 hours from the time of the block placement
Eligibility Criteria
Criteria
Inclusion Criteria:
- Patients aged 1 to 9 years old scheduled for intravesicular ureteral reimplantation surgery
Exclusion Criteria:
-
Coagulation status or anatomic variations precluded safe placement of either TAPB or caudal epidural,
-
there was a preexisting chronic pain disorder,
-
there was a history of constipation that persisted despite appropriate treatment and that may have impacted postoperative pain assessments,
-
additional procedures were planned via a separate incision at the time of the ureteral reimplantation, 5) there was a contraindication to receiving the medications described in the protocol.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Wolfson Children's Hospital, Baptist Medical Center- Downtown, 800 Prudential Drive | Jacksonville | Florida | United States | 32207 |
Sponsors and Collaborators
- Nemours Children's Clinic
Investigators
- Principal Investigator: Robert B Bryskin, MD, Nemours Children's Clinic
Study Documents (Full-Text)
None provided.More Information
Publications
- Tripi PA, Palmer JS, Thomas S, Elder JS. Clonidine increases duration of bupivacaine caudal analgesia for ureteroneocystostomy: a double-blind prospective trial. J Urol. 2005 Sep;174(3):1081-3.
- Vetter TR, Carvallo D, Johnson JL, Mazurek MS, Presson RG Jr. A comparison of single-dose caudal clonidine, morphine, or hydromorphone combined with ropivacaine in pediatric patients undergoing ureteral reimplantation. Anesth Analg. 2007 Jun;104(6):1356-63, table of contents.
- 1610841001