Contribution of Ultrasound-Guided Transversus Abdominis Plane Block to Intraoperative Anesthesia in children - Randomized Controlled Study

İLKE Küpeli; MUSTAFA YAŞAR Özdamar

doi:10.7197/223.v40i37154.366688

Araştırma Makalesi

Contribution of Ultrasound-Guided Transversus Abdominis Plane Block to Intraoperative Anesthesia in children - Randomized Controlled Study

Yıl 2018, Cilt: 40 Sayı: 2, 166 - 174, 05.06.2018

İLKE Küpeli , MUSTAFA YAŞAR Özdamar

https://doi.org/10.7197/223.v40i37154.366688

Öz

Aim: The aim of this study is to investigate the contribution of transversus abdominis plane (TAP) block supported by intravenous ketamine sedation in children on intraoperative anesthesia and analgesia.

Method: A total of 60 patients aged between 2 and 6 years, were included in the study. The patients were divided in three groups; the TAP block and ketamine group; the TAP block by inserting the laryngeal mask(LMA) and sevoflurane grup; and the LMA and sevoflurane group. Peroperative heart rates(HR), mean arterial pressures(MAP), amount of sevoflurane used, postoperative pain scores, number of children needing rescue analgesia, time required for the first analgesia were recorded.

Results: Of the patients average age was 4 ± 1.1. There was no difference between the two block groups, in terms of HR and MAP; HR were higher and MAP were lower in the only sevoflurane group. In the group supported by a TAP block, the amount of sevoflurane used decreased(p<005). In the postoperative period, the HR, MAP and pain scores were higher in the only sevoflurane group(p <0,05). Rescue analgesia was applied to less number of patients in the groups with added block. There were longer analgesia durations in the block-supported groups(p<0.05).

Conclusion: In this study, it was determined that TAP block added to general anesthesia or sedation in pediatric lower abdominal surgery reduced the need for intraoperative anesthesia, provided a more stable intraoperative hemodynamics and analgesia, and provided less pain scores, longer analgesia duration and less analgesia need in the postoperative period.

Anahtar Kelimeler

children, Ultrasound-Guided Transversus Abdominis Plane Block, Intraoperative Anesthesia

Kaynakça

1. Lacroix F. Epidemiology and morbidity of regional anaesthesia in children. Curr Opin Anaesthesiol. 2008;21(3):345-9.
2. Willschke H, Marhofer P, Machata AM, Lonnqvist PA. Current trends in paediatric regional anaesthesia. Anaesthesia. 2010;65 Suppl 1:97-104.
3. Mishriky BM, George RB, Habib AS. Transversus abdominis plane block for analgesia after Cesarean delivery: a systematic review and meta-analysis. Can J Anaesth. 2012;59(8):766-78.
4. Schaeffer E, Millot I, Landy C, Nadaud J, Favier JC, Plancade D. Another use of continuous transversus abdominis plane (TAP) block in trauma patient: pelvic ring fractures. Pain Med. 2014;15(1):166-7.
5. Niraj G, Kelkar A, Fox AJ. Application of the transversus abdominis plane block in the intensive care unit. Anaesth Intensive Care. 2009;37(4):650-2.
6. Walter CJ, Maxwell-Armstrong C, Pinkney TD, Conaghan PJ, Bedforth N, Gornall CB, et al. A randomised controlled trial of the efficacy of ultrasound-guided transversus abdominis plane (TAP) block in laparoscopic colorectal surgery. Surg Endosc. 2013;27(7):2366-72.
7. Stuart-Smith K. Hemiarthroplasty performed under transversus abdominis plane block in a patient with severe cardiorespiratory disease. Anaesthesia. 2013;68(4):417-20.
8. Tekelioglu UY, Demirhan A, Sit M, Kurt AD, Bilgi M, Kocoglu H. Colostomy with Transversus Abdominis Plane Block. Turk J Anaesthesiol Reanim. 2015;43(6):424-6.
9. Alsadek WM, Al-Gohari MM, Elsonbaty MI, Nassar HM, Alkonaiesy RM. Ultrasound guided TAP block versus ultrasound guided caudal block for pain relief in children undergoing lower abdominal surgeries. Egyptian Journal of Anaesthesia. 2015;31(2):155-60.
10. McDonnell JG, O'Donnell B, Curley G, Heffernan A, Power C, Laffey JG. The analgesic efficacy of transversus abdominis plane block after abdominal surgery: a prospective randomized controlled trial. Anesth Analg. 2007;104(1):193-7.
11. O'Donnell BD, McDonnell JG, McShane AJ. The transversus abdominis plane (TAP) block in open retropubic prostatectomy. Reg Anesth Pain Med. 2006;31(1):91.
12. Kim SH, Chun DH, Chang CH, Kim TW, Kim YM, Shin YS. Effect of caudal block on sevoflurane requirement for lower limb surgery in children with cerebral palsy. Paediatr Anaesth. 2011;21(4):394-8.
13. Tanaka M, Mori N, Murakami W, Tanaka N, Oku K, Hiramatsu R, et al. [The effect of transversus abdominis plane block for pediatric patients receiving bone graft to the alveolar cleft]. Masui. 2010;59(9):1185-9.
14. Carney J, Finnerty O, Rauf J, Curley G, McDonnell JG, Laffey JG. Ipsilateral transversus abdominis plane block provides effective analgesia after appendectomy in children: a randomized controlled trial. Anesth Analg. 2010;111(4):998-1003.
15. Ramzy Shaaban A. Ultrasound guided transversus abdominis plane block versus local wound infiltration in children undergoing appendectomy: A randomized controlled trial. Egyptian Journal of Anaesthesia. 2014;30(4):377-82.
16. Dahmani S, Stany I, Brasher C, Lejeune C, Bruneau B, Wood C, et al. Pharmacological prevention of sevoflurane- and desflurane-related emergence agitation in children: a meta-analysis of published studies. Br J Anaesth. 2010;104(2):216-23.

Çocuklarda ultrason eşliğinde transversus abdominis plane bloğun intraoperatif anesteziye katkısı- randomize kontrollü çalışma

Yıl 2018, Cilt: 40 Sayı: 2, 166 - 174, 05.06.2018

İLKE Küpeli , MUSTAFA YAŞAR Özdamar

https://doi.org/10.7197/223.v40i37154.366688

Öz

Amaç: Bu çalışmanın amacı,çocuklarda intravenöz ketamin sedasyonuyla
desteklenen transversus abdominis plane(TAP) bloğun intraoperatif anesteziye ve
analjeziye katkısını araştırmaktır.

Yöntem: 2-6
yaş arası toplam 60 hasta çalışmaya dahil edilmiştir. Hastalar 3 gruba ayrıldı;
TAP blok ve ketamin grubu; larıngeal maske takılarak(LMA) TAP blok yapılan
ve sevofluran grubu; LMA ve sevofluran grubu. Peroperatif kalp hızları(KH), ortalama arter basınçları(OAB),
kullanılan sevofluran miktarı, postoperatif ağrı skorları, kurtarma
analjezisine ihtiyaç olan çocuk sayısı, ilk analjeziye ihtiyaç duyulan zaman
kaydedildi.

Bulgular: Hastaların yaş
ortalaması 4±1,1 idi. İki blok grup arasında KH ve OAB açısından fark yoktu;
sadece sevofluran grubunda KH daha yüksek ve OAB daha düşüktü. TAP bloğu
tarafından desteklenen grupta, kullanılan sevofluran miktarı azalmıştı(p
<005). Postoperatif dönemde sadece sevofluran grubunda KH, OAB ve ağrı
skorları daha yüksek bulundu(p <0,05). Blok eklenen gruplarda daha az sayıda
hastaya kurtarma analjezi uygulandı. Blok destekli gruplarda daha uzun analjezi
süreleri vardı(p <0.05).

Sonuç: Bu çalışma ile, pediatrik alt batın
cerrahisinde, genel anestezi ya da sedasyona eklenen TAP bloğun, intraoperatif
anestezi ihtiyacını azalttığı, daha stabil intraoperatif hemodinami ve analjezi sağladığı,
postoperatif dönemde ise daha düşük ağrı skorları, daha uzun analjezi süresi ve
daha az analjezi ihtiyacı sağladığı saptanmıştır.

Anahtar Kelimeler

çocuk; ultrason eşliğinde transversus abdominis plane(TAP) blok; intraoperatif anestezi;

Kaynakça

1. Lacroix F. Epidemiology and morbidity of regional anaesthesia in children. Curr Opin Anaesthesiol. 2008;21(3):345-9.
2. Willschke H, Marhofer P, Machata AM, Lonnqvist PA. Current trends in paediatric regional anaesthesia. Anaesthesia. 2010;65 Suppl 1:97-104.
3. Mishriky BM, George RB, Habib AS. Transversus abdominis plane block for analgesia after Cesarean delivery: a systematic review and meta-analysis. Can J Anaesth. 2012;59(8):766-78.
4. Schaeffer E, Millot I, Landy C, Nadaud J, Favier JC, Plancade D. Another use of continuous transversus abdominis plane (TAP) block in trauma patient: pelvic ring fractures. Pain Med. 2014;15(1):166-7.
5. Niraj G, Kelkar A, Fox AJ. Application of the transversus abdominis plane block in the intensive care unit. Anaesth Intensive Care. 2009;37(4):650-2.
6. Walter CJ, Maxwell-Armstrong C, Pinkney TD, Conaghan PJ, Bedforth N, Gornall CB, et al. A randomised controlled trial of the efficacy of ultrasound-guided transversus abdominis plane (TAP) block in laparoscopic colorectal surgery. Surg Endosc. 2013;27(7):2366-72.
7. Stuart-Smith K. Hemiarthroplasty performed under transversus abdominis plane block in a patient with severe cardiorespiratory disease. Anaesthesia. 2013;68(4):417-20.
8. Tekelioglu UY, Demirhan A, Sit M, Kurt AD, Bilgi M, Kocoglu H. Colostomy with Transversus Abdominis Plane Block. Turk J Anaesthesiol Reanim. 2015;43(6):424-6.
9. Alsadek WM, Al-Gohari MM, Elsonbaty MI, Nassar HM, Alkonaiesy RM. Ultrasound guided TAP block versus ultrasound guided caudal block for pain relief in children undergoing lower abdominal surgeries. Egyptian Journal of Anaesthesia. 2015;31(2):155-60.
10. McDonnell JG, O'Donnell B, Curley G, Heffernan A, Power C, Laffey JG. The analgesic efficacy of transversus abdominis plane block after abdominal surgery: a prospective randomized controlled trial. Anesth Analg. 2007;104(1):193-7.
11. O'Donnell BD, McDonnell JG, McShane AJ. The transversus abdominis plane (TAP) block in open retropubic prostatectomy. Reg Anesth Pain Med. 2006;31(1):91.
12. Kim SH, Chun DH, Chang CH, Kim TW, Kim YM, Shin YS. Effect of caudal block on sevoflurane requirement for lower limb surgery in children with cerebral palsy. Paediatr Anaesth. 2011;21(4):394-8.
13. Tanaka M, Mori N, Murakami W, Tanaka N, Oku K, Hiramatsu R, et al. [The effect of transversus abdominis plane block for pediatric patients receiving bone graft to the alveolar cleft]. Masui. 2010;59(9):1185-9.
14. Carney J, Finnerty O, Rauf J, Curley G, McDonnell JG, Laffey JG. Ipsilateral transversus abdominis plane block provides effective analgesia after appendectomy in children: a randomized controlled trial. Anesth Analg. 2010;111(4):998-1003.
15. Ramzy Shaaban A. Ultrasound guided transversus abdominis plane block versus local wound infiltration in children undergoing appendectomy: A randomized controlled trial. Egyptian Journal of Anaesthesia. 2014;30(4):377-82.
16. Dahmani S, Stany I, Brasher C, Lejeune C, Bruneau B, Wood C, et al. Pharmacological prevention of sevoflurane- and desflurane-related emergence agitation in children: a meta-analysis of published studies. Br J Anaesth. 2010;104(2):216-23.

Toplam 16 adet kaynakça vardır.

Ayrıntılar

Birincil Dil	İngilizce
Konular	Sağlık Kurumları Yönetimi
Bölüm	Cerrahi Tıp Bilimleri Araştırma Yazıları
Yazarlar	İLKE Küpeli MUSTAFA YAŞAR Özdamar
Yayımlanma Tarihi	5 Haziran 2018
Kabul Tarihi	12 Mart 2018
Yayımlandığı Sayı	Yıl 2018Cilt: 40 Sayı: 2

Kaynak Göster

AMA	Küpeli İ, Özdamar MY. Contribution of Ultrasound-Guided Transversus Abdominis Plane Block to Intraoperative Anesthesia in children - Randomized Controlled Study. CMJ. Haziran 2018;40(2):166-174. doi:10.7197/223.v40i37154.366688