Pediatrik hastalarda alt batın cerrahisi için TAP blok konforu

Amaç: Bu çalışmada pediatrik hasta grubunda alt karın ameliyatı sonrası uygulanan transversus abdominis plan (TAP) bloğunun ağrı şiddeti ve ek analjezik ihtiyacına etkisini araştırmayı amaçladık. Gereç ve Yöntem: Retrospektif gerçekleştirilen bu çalışmada abdominal cerrahi geçiren 2-18 yaş arası ASA I 46 çocuk iki gruba ayrıldı. Grup T(n:20) hastalarına genel anestezi altında operasyon tamamlandıktan hemen sonra 0.5 mL/kg %0.25 bupivakain ile ultrasonografik kılavuzluk eşliğinde TAP blok uygulandı. Grup O(n:26) hastalarına genel anesteziden ayılma sonrasında intravenöz(i.v.) 2 µcg/kg dozunda opioid(fentanil) analjezisi uygulandı. Derlenme ve ilk ağrı gözlemi için hastalar postanestezik bakım ünitesine(PACU) alındı. Ameliyat sonrası ağrı, ameliyattan sonra ki ilk 24 saat içinde Visual Analog Skala(VAS) skoru ile değerlendirildi. Bulgular: TAP blok uygulanan olgularda ek aneljezik ihtiyacı görülme oranı(%15), I.V opioid uygulananlardan istatistiksel olarak anlamlı düzeyde daha düşüktü(%65). TAP blok uygulanma durumuna göre olguların ilk aneljezi ihtiyacı için geçen süreleri ve taburculuk süreleri arasında fark mevcut ancak istatistiksel olarak anlamlı değildi. TAP blok uygulanan olguların 4.saat ve 8. saat VAS skorları, I.V. opioid uygulanan gruba göre istatistiksel olarak anlamlı düzeyde daha düşük saptandı (4.VAS:4.90±1,21 5.90±0.85; 8.VAS:4.05±0.76 3.10±0.85). Her iki grupta da ameliyattan 2 saat sonra değerlendirilen VAS skorlarında azalma vardı. Ancak TAP blok uygulanan grupta 2. Saat VAS skorunda daha fazla düşme mevcuttu. Sonuç: Abdominal cerrahi geçiren pediatrik hastalarda TAP blok ek analjezik ihtiyacını azaltma açısından I.V. opioide kıyasla daha üstün bulundu. Erken mobilizasyona olanak sağladığı için erken taburculuğa da katkısı olacaktır.

Anahtar Kelimeler:

TAP blok, çocuk hasta, abdominal cerrahi, VAS, opioid

TAP block comfort for lower abdominal surgery in pediatric patients

Purpose: The aim of this study was to examine the effect of The transversus abdominis plane (TAP) block after lower abdominal surgery on pain severity and additional analgesic requirement in a pediatric patient group. Materials and Methods: In this retrospective study, 46 ASA I children aged 2-18 years undergoing abdominal surgery were divided into two groups. Group T (n: 20) patients who were under the general anesthesia received ultrasound-guided TAP block with 0.5 mL/kg of 0.25% bupivacaine immediately after the operation. Group O (n: 26) patients were administered intravenous (I.V.) 2 µcg/kg opioid (fentanyl) analgesia after recovery from general anesthesia. The patients were taken to the post-anesthesia care unit (PACU) for recovery and initial pain observation. Patients pain was assessed by using the Visual Analogue Scale (VAS) score within the first 24 hours following surgery. Results: The incidence of the additional analgesic requirement in the TAP block(%15) group was statistically significantly lower than in the I.V. opioid group(%65). There was a difference between the first analgesic requirement and the discharging time according to TAP block administration, but it was statistically insignificant. The VAS scores at 4 hr and 8 hr in the TAP block group were statistically significantly lower than in the IV opioid group(4.VAS:4.90±1,21 5.90±0.85; 8.VAS:4.05±0.76 3.10±0.85). The VAS scores at postoperative 2 hr were decreased in both groups. However, the decrease in the VAS score at 2 hr was greater in the TAP block group. Conclusion: TAP block was superior to IV opioids in reducing additional analgesic requirements in pediatric patients undergoing abdominal surgery. It will contribute further to early discharging a patient as it allows early mobilization.

Keywords:

TAP block, pediatric patient, abdominal surgery, VAS, opioid,

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