TAPB vs. Caudal for Lower Abdominal Surgery in Children: A Double-Blinded Randomized Controlled Trial

Nemours Children's Health

Status and phase: Completed; Phase 4

Conditions: Anesthesia, Recovery Period

Treatments: Procedure: Transversus Abdominis Plane Block; Procedure: Caudal Epidural

Study type: Interventional

Funder types: Other

Identifiers

NCT02160821

1610841001

Details and patient eligibility

About

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.

Full 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.

Enrollment: 45 patients

Sex: All

Ages: 1 to 9 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Patients aged 1 to 9 years old scheduled for intravesicular ureteral reimplantation surgery

Exclusion criteria

1. Coagulation status or anatomic variations precluded safe placement of either TAPB or caudal epidural,
2. there was a preexisting chronic pain disorder,
3. there was a history of constipation that persisted despite appropriate treatment and that may have impacted postoperative pain assessments,
4. 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.

Trial design

Primary purpose: Supportive Care

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Triple Blind

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45 participants in 2 patient groups

Transversus Abdominis Plane Block

Experimental group

Description:

Transversus Abdominis Plane Block TAPB Ultrasound guided TAPB

Treatment:

Procedure: Transversus Abdominis Plane Block

Caudal Epidural Block

Experimental group

Description:

Caudal Epidural Block Caudal Block Neuraxial Block Ultrasound Guided Caudal Block

Treatment:

Procedure: Caudal Epidural