الفهرس 
List of abbreviationsOnly 14 pages are availabe for public view
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Abstract
The impact of painful experience on the young nervous system is so significant that long-term effects can occur, including a lowered pain tolerance for months after a pain-producing event.
However, the benefits of adequate analgesia include attenuation of the surgical stress response, decreased perioperative morbidity and improved outcome in certain types of surgery. Also, effective pain control facilitates rehabilitation and accelerates recovery from surgery.
Regional anesthesia and analgesia techniques are commonly used to facilitate pain control during pediatric surgical practice, decrease parenteral opioids requirements and improve the quality of post-operative pain control and patient parent satisfaction.
Caudal epidural block (CEB) is the most common regional anesthesia technique employed in pediatrics lower abdominal procedures because of its effective control of both somatic and visceral pain with a low complication rate (0.7 per 1000). In addition to significant reduction of intraoperative analgesic requirements and upper airway complications.
Complication from caudal epidural block is rare but serious ,so trends are shifted toward peripheral nerve blocks or infiltration blocks.
However, there is a trend toward the use of peripheral nerve blockade wherever applicable due to its lower incidence of complications than neuron-axial techniques and ability to overcome some specific contraindications that preclude the use of (CEB) Also, the use of ultrasound allowed real-time visualization of anatomical structures, guiding the blocking procedure itself and showing the spread of the local anesthetic solution injected.
The transversus abdominis plane thus provides a space into which local anesthetic can be deposited to achieve myo-cutaneous sensory blockade through transversus abdominis plane (TAP) block.
This study aimed to the assessment of analgesic effects between TAP block and caudal epidural block in children undergoing infraumblical surgeries through evaluation of hemodynamic stability (intra-operative), side effects (from technique and drug used) and pain-free period (time of the first dose and the total dose of analgesia needed by patient postoperatively).
This prospective randomized double blinded clinical trial was conducted on 120 children, aged between 4 and 7 years undergoing infra umbilical surgeries selected according to ASA physical status class I to II from both genders. Patients were arranged into two equal groups:
group 1 (C): Caudal block group (n= 60): received caudal epidural
block.
group 2 (T): TAP block group (n =60): received ultrasound-guided
transversus abdominis plane (TAP) block.
All participants were subjected to preoperative assessment (history taking, physical examination, laboratory investigations for CBC, and coagulation profile), intraoperative measurements (hemodynamic parameters), and postoperative measurements (pain assessments, first rescue analgesia, the total dose of paracetamol required, the general satisfaction of their parent and incidence of postoperative complications).
Summary of results
• Faces pain scale-revised was significantly lower in group 1 compared to group 2 at 8 and 18 h postoperatively.
• Postoperative heart rate was significantly lower in group 1 compared to group 2 at 8 and 18 h postoperatively.
• Postoperative mean arterial pressure was significantly lower in group 1 compared to group 2 at 8 and 18 h postoperatively.
• FPS-R scale was significantly lower in group 1 compared to group 2.
• Respiratory rate was insignificantly different between group 1 and group 2 at all-time measurements.
• Time of 1st rescue analgesia was significantly delayed at group 1 compared to group 2.
• Total paracetamol requirements were significantly lower in group 1 compared to group 2.
• Post operative complications were insignificantly different between group 1 and group 2.
Conclusion
In children undergoing lower abdominal surgeries, caudal block provides superior analgesia compared to TAP block the at 6–24 hours after block placement, as demonstrated by a reduced requirement of systemic analgesics including paracetamol in the postoperative period leading to enhanced recovery and lower pain scores 6–24 hours postoperatively. Considering the overall safety advantages of the caudal block over the TAP block, caudal block is an effective, viable and safe for postoperative analgesia.
Limitation
• Relatively small sample size.
• The study did not assess motor effects of the block.
• Short assessment of postoperative analgesia limited to the first 24 postoperative hours.
• It was a single-center study, and the results may differ elsewhere.
Recommendations
• Further prospective studies are needed in order to validate these findings.
• Multi-centric prospective studies are needed to further determine the analgesic efficiency of both TAP and caudal blocks.