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Analgesic efficacy of ultrasound-guided modified thoracoabdominal nerve block in paediatric upper abdominal surgery:
Athira Jayan1, Amarjeet Kumar1, Chandni Sinha1
1Department of Anaesthesiology, All India Institute of Medical Sciences, Patna, Bihar, India.
Insights
Ultrasound-guided modified thoracoabdominal nerve block (mTAPA) significantly reduced intraoperative opioid use in children undergoing upper abdominal surgery. This technique also lowered postoperative pain scores and the need for rescue analgesia.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pain Management
Background:
- Effective postoperative pain management is critical for pediatric recovery.
- Ultrasound-guided nerve blocks offer targeted analgesia.
- The modified thoracoabdominal nerve block through perichondrial approach (mTAPA) is a novel technique.
Purpose of the Study:
- To evaluate the analgesic efficacy of the US-guided mTAPA block in pediatric patients undergoing upper abdominal surgery.
- To compare opioid consumption and pain scores between patients receiving mTAPA block plus general anesthesia and those receiving general anesthesia alone.
Main Methods:
- A randomized controlled trial involving 40 pediatric patients (2-8 years) undergoing unilateral upper abdominal surgery.
- Group I received general anesthesia (GA) with US-guided mTAPA block (0.2% ropivacaine); Group II received GA only.
- Primary outcome: intraoperative opioid consumption; Secondary outcomes: postoperative pain, 24-h opioid consumption, adverse effects.
Main Results:
- Group I showed significantly lower intraoperative fentanyl consumption (10.0 µg vs. 20 µg, P=0.001).
- Fewer patients in Group I required rescue opioid top-ups (32.5% vs. 50%).
- Postoperative pain scores were reduced in Group I for up to 16 hours, with a longer time to rescue analgesia.
Conclusions:
- Ultrasound-guided mTAPA block is an effective adjunct to GA for pediatric upper abdominal surgery.
- The technique significantly reduces opioid requirements and improves pain control post-surgery.
- No significant adverse effects were noted in the mTAPA block group.
Background And Aims:
Adequate pain management is crucial for postoperative recovery in paediatric patients. This study aimed to evaluate the analgesic efficacy of ultrasound (US)-guided modified thoracoabdominal nerve block through perichondrial approach (mTAPA) block in paediatric patients undergoing upper abdominal surgeries.
Methods:
This randomised controlled trial included 40 paediatric patients aged between 2 and 8 years scheduled for unilateral upper abdominal surgeries. Patients were randomised into two groups: Group I received general anaesthesia (GA) with US-guided mTAPA block (0.5 mL/kg of 0.2% ropivacaine), while Group II received GA only. Intravenous fentanyl 0.5 µg/kg was utilised for perioperative pain management. The primary outcome was to assess intraoperative opioid consumption, whereas secondary outcomes were postoperative pain scores, 24-h opioid consumption, and adverse effects such as nausea and vomiting. The independent Student t-test compared quantitative, normally distributed data, while the Mann-Whitney U test compared quantitative, discrete data. A P value of <0.05 was considered statistically significant.
Results:
Patients in Group I had a statistically lower intraoperative median fentanyl consumption of 10.0 µg [range: 0-20, interquartile range (IQR): 0-10] versus 20 µg (range: 5-48, IQR: 20-27) in Group II (P = 0.001). There was a significant reduction in the number of patients requiring rescue opioid top-ups (32.5% vs 50%) and postoperative pain scores (till 16 hours) in Group I. The median time to rescue analgesia was significantly higher in Group I than Group II (P = 0.001). No significant side effects were observed in either group.
Conclusion:
Ultrasound-guided modified thoracoabdominal nerve block through perichondrial approach as an adjunct to general anaesthesia provides effective analgesia by significantly reducing opioid consumption in paediatric patients undergoing upper abdominal surgeries through a unilateral subcostal incision.
