Ultrasound Guided Erector Spinae Plane Block Versus Transverses Abdominis Plane Block for Post-Operative Analgesia in Pediatric Patients Undergoing Laparoscopic Inguinal Hernia Repair: A Randomized Controlled Trial

Background: Inguinal hernia repair is one of the most common surgical procedures in the pediatric age group and it is associated with significant post-operative discomfort. The aim of this study is to compare the safety, reliability, and efficacy of ultrasound-guided transverses abdominis plane (TAP) block versus erector spinae plane (ESP) block for postoperative pain control in pediatrics undergoing laparoscopic inguinal hernia repair.

Methods: This prospective randomized study was carried out on 90 pediatric patients of both sexes aged (2 -7) years with ASA physical status I/II scheduled for elective laparoscopic inguinal hernia repair. Patients were divided into 3 equal groups. Group C received general anesthesia alone. group T received bilateral ultrasound-guided TAP block after induction of general anesthesia with the injection of 0.4 ml/kg bupivacaine 0.25%. group E received bilateral ultrasound-guided ESP block after induction of general anesthesia with the injection of 0.4 ml/kg bupivacaine 0.25%.

Results: According to CHEOPS, we found no statistically significant difference between ESP and TAP groups but significant increase in the control group. also, There was a significant decrease in total rescue analgesia (intra-operative & postoperative ) in the T group and E as compared to group C. Also there was a significant delay in onset of first rescue analgesia post operatively between group T&E in comparison to group C. The mean value of heart rate between the 3 groups showed no statistically significant difference between TAP and ESP groups intra-operatively but significant increase in heart rate in the control group in all stages of the operation as compared to T& E groups. Mean arterial blood pressure changes were insignificant between three groups in all stages of operation.

Conclusions: TAP block and ESP block are effective and safe techniques for postoperative pain control in pediatric patients undergoing laparoscopic inguinal hernia repair with more hemodynamic stability, less intra and postoperative analgesia requirement.