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Published on: January 31, 2025
Ultrasound-guided procedures for postoperative pain management in pediatric patients undergoing abdominal surgeries:
Suresh K Thanneeru1, Molli Kiran2, Sri R A N Padala2
1Department of Pediatric Surgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.
Insights
This review compares ultrasound-guided nerve blocks for pediatric abdominal surgery pain. Transversus abdominis block is common, but efficacy varies, highlighting the need for standardized RCTs to optimize pediatric postoperative analgesia.
Area of Science:
- Anesthesiology and Pain Management
- Pediatric Surgery
- Regional Anesthesia
Background:
- Ultrasound-guided peripheral nerve blockade is crucial for pediatric analgesia.
- Selecting optimal procedures for pediatric abdominal surgery pain management remains a challenge.
Purpose of the Study:
- To systematically review and compare ultrasound-guided procedures for pediatric abdominal surgery analgesia.
- To assess efficacy, procedure duration, and suitability for specific surgeries.
- To identify optimal techniques for postoperative pain management in children.
Main Methods:
- Systematic literature search of PubMed, SCOPUS, Cochrane Library, and ScienceDirect.
- Inclusion of randomized controlled trials (RCTs) involving pediatric patients undergoing abdominal surgery.
- Exclusion of non-RCTs, case reports, and non-English studies.
Main Results:
- Reviewed 13 articles with 910 pediatric patients (6 months to 21 years).
- Transversus abdominis block (47.76%) and hernia/hydrocele surgeries (52.10%) were most common.
- No complications reported; however, transversus abdominis block showed variable efficacy in two studies.
Conclusions:
- Ultrasound-guided regional anesthesia offers diverse options for pediatric abdominal surgery pain.
- Each block technique has unique benefits and drawbacks, necessitating tailored approaches.
- Further RCTs are essential to compare efficacy, standardize practices, and enhance pediatric postoperative outcomes.
Abstract:
Many ultrasound-guided procedures are available for administering analgesia via peripheral nerve blockade. This systematic review aims to compare different ultrasound-guided procedures to determine which procedure is better suited for pediatric abdominal surgeries. The objective is to understand the efficacy of ultrasound-guided procedures for postoperative pain management in children undergoing abdominal surgeries and to identify which procedure takes less time and is better suited for a particular surgery. A systematic literature search was performed in PubMed, SCOPUS, Central Cochrane Registry of Controlled Trials (The Cochrane Library), and ScienceDirect databases for pediatric abdominal surgeries conducted with ultrasound-guided procedures for administering analgesia. We included studies involving randomized controlled trials (RCTs). Quasi-randomized controlled studies, prospective, retrospective observational studies, case series, case reports, letters, editorials, comments, animal studies, and studies from non-English literature were excluded. We reviewed 13 articles with 910 patients included. Age groups varied from 6 months to 21 years. The most common block used was the transversus abdominis block (47.76%), and the most common surgery performed was hernia and hydrocele (52.10%). Quadratus lumborum block was used in 26.92%, erector spinae block in 8.97%, modified transversus abdominus block and rectus sheath block in 9.62%, and ilioinguinal block in 6.73% of the patients. No complications were reported in any of the studies. Transversus abdominus block is less effective in two of the studies. Each procedure for pediatric postoperative analgesia has specific advantages and limitations, highlighting the complexity of tailoring interventions. Our review focuses on the advancements in ultrasound-guided analgesia for lower abdominal surgeries in pediatric patients while also emphasizing the need for future randomized controlled trials (RCTs) to compare efficacy, standardize practices, and improve patient outcomes.
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