Laparoscopic versus ultrasound-guided transversus abdominis plane block versus laparoscopic intraperitoneal instillation of local anesthetic in pediatrics undergoing inguinal hernia repair: a randomized controlled trial | ||||
| International Journal of Medical Arts | ||||
| Articles in Press, Accepted Manuscript, Available Online from 09 August 2025 | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/ijma.2025.396789.2203 | ||||
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| Authors | ||||
Ahmed Mohammed Ibrahim  1; Doha Mohammed Bakr 2; Amir Ismail Ibrahim Abo Mostafa3; Ahmed A Elhaddad3; Mai Kamal Abdallah4; Esraa Hassan Abdelwahab4; Rehab Abd Elfattah Helal5
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| 1Anesthesiology, Surgical Intensive Care and Pain Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt | ||||
| 2Anesthesia, Surgical Intensive Care, and Pain Management Department, Faculty of Medicine, Helwan University, Helwan, Egypt | ||||
| 3Pediatric Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt | ||||
| 4Anesthesiology, Surgical Intensive Care and Pain Management Department, Faculty of Medicine, Tanta University, Tanta, Egypt | ||||
| 5Anesthesiology Surgical Intensive Care and Pain Management Faculty of Medicine, Tanta University, Tanta, Egypt | ||||
| Abstract | ||||
| Background: Significant pain and discomfort post inguinal hernia repairing surgeries are often reported in surgical units concerning pediatrics. In this trial, we compared the analgesic effects of ultrasound-guided transversus abdominis plane block (UTAPB), laparoscopic guided transversus abdominis plane block (LTAPB), and laparoscopic intraperitoneal instillation (IPIN) of local anesthetic (LA) for pediatrics undergoing laparoscopic inguinal hernia repair (LIHR). Methods: This randomized trial included 66 pediatrics aged between two months and seven years and planned for LIHR. They were divided into three equal groups: a control group received UTAPB, a second group received LTAPB, and a third group received IPIN of LA into the peritoneal cavity. Each block was administered using a standardized dose of 1 ml/kg bupivacaine 0.25% with 20 mL maximum volume. The primary outcome was pethidine consumption in the first 24 hours after surgery. Results: UTAPB and LTAPB groups had significantly lower total pethidine consumption compared to the IPIN of LA group (p < 0.001), with a significantly longer time to first rescue analgesia (p < 0.001). Pain scores at 2, 4, and 6 hours after surgery were significantly lower in the UTAPB and LTAPB groups than in the IPIN of LA group (p < 0.05). No significant variances were noted in postoperative pain scores, time to rescue analgesia, and overall pethidine consumption between the UTAPB and LTAPB groups. Conclusions: In children undergoing LIHR, both UTAPB and LTAPB were found to be more effective than IPIN of LA in decreasing pain scores, delaying the need for rescue analgesia, and decreasing overall opioid use during the initial 24 hours after operation, with comparable analgesic effect between UTAPB and LTAPB. | ||||
| Keywords | ||||
| Inguinal Hernia; Laparoscopic; Intraperitoneal Instillation; Pediatric; Transversus Abdominis Plane Block | ||||
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