The effect of ultrasound-guided transversus abdominis plane (TAP) block on postoperative analgesia and neuroendocrine stress response in pediatric patients undergoing elective open inguinal hernia repair

• Published in: Pediatric anesthesia 2016-12, Vol.26 (12), p.1165-1171
• Main Authors: Abu Elyazed, Mohamed M., Mostafa, Shaimaa F., Abdullah, Mohammad A., Eid, Gehan M.
• Format: Article
• Language: English
• Subjects: Abdominal Muscles - drug effects; Abdominal Muscles - innervation; Analgesia - methods; Blood Glucose; Child; Child, Preschool; Elective Surgical Procedures; Female; general anesthesia; Hernia, Inguinal - surgery; Humans; Hydrocortisone - blood; local anesthetics; Male; measurement; Nerve Block - methods; Neurosecretory Systems - drug effects; Neurosecretory Systems - physiopathology; pain; Pain, Postoperative - blood; Pain, Postoperative - drug therapy; Patient Satisfaction - statistics & numerical data; regional; Stress, Physiological - drug effects; Ultrasonography, Interventional - methods
• ISSN: 1155-5645; 1460-9592
• DOI: 10.1111/pan.12999

Summary Background Transversus abdominis plane block (TAP) is a compartmental block of the anterior abdominal wall. Surgical trauma produces multisystem reactions. Anesthetic techniques can modify the neuroendocrine surgical stress response. Aim The aim of this study was to evaluate the effect of TAP block on the modification of the surgical neuroendocrine stress response as well as its analgesia effect in children undergoing open inguinal hernia repair. Method Sixty children aged 3–10 years undergoing elective unilateral open inguinal hernia repair were randomized into group I (general anesthesia) or group II (received TAP block after induction of general anesthesia). Serum cortisol, blood glucose, quality of analgesia, postoperative need for rescue analgesia, and complications and degree of satisfaction of the patients and their parents were assessed. Results Serum cortisol level was significantly lower in group II as compared to group I intraoperatively (17.73 ± 1.51 vs 21.80 ± 2.22 μg·dl−1) and 30 min postoperatively (15.03 ± 1.56 vs 18.30 ± 1.53 μg·dl−1). Blood glucose level was significantly lower in group II as compared to group I intraoperatively (107.57 ± 3.77 vs 115.40 ± 6.30 mg·dl−1) and 30 min postoperatively (104.13 ± 3.78 vs 110.73 ± 4.83 mg·dl−1). The quality of analgesia as indicated by CHEOPS and OPS scales was significantly better in group II. The consumption of postoperative rescue analgesia was significantly higher in group I as compared to group II (27.00 ± 9.97 vs 13.00 ± 9.43 mg·kg−1). Conclusion TAP block is effective as a part of multimodal analgesia for children undergoing open inguinal hernia repair with significant attenuation in the neuroendocrine stress response induced by surgery.