Caudal block vs. transversus abdominis plane block for pediatric surgery: a systematic review and meta-analysis
BackgroundThe caudal block and transversus abdominis plane block (TAP) are commonly used in combination with general anesthesia for pediatric lower abdominal, inguinal, and genitourinary surgeries. There is limited data directly comparing the impact of these techniques on recovery. In this meta-anal...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-05-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2023.1173700/full |
| _version_ | 1797815214503100416 |
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| author | Michael Hafeman Seth Greenspan Emiliya Rakhamimova Zhaosheng Jin Robert P. Moore Ehab Al Bizri |
| author_facet | Michael Hafeman Seth Greenspan Emiliya Rakhamimova Zhaosheng Jin Robert P. Moore Ehab Al Bizri |
| author_sort | Michael Hafeman |
| collection | DOAJ |
| description | BackgroundThe caudal block and transversus abdominis plane block (TAP) are commonly used in combination with general anesthesia for pediatric lower abdominal, inguinal, and genitourinary surgeries. There is limited data directly comparing the impact of these techniques on recovery. In this meta-analysis, we compare the duration of postoperative analgesia between these two techniques.ObjectiveThis review examined the duration of analgesia in pediatric patients (age 0–18 years) undergoing surgery who received caudal or TAP block after induction of general anesthesia. The primary outcome was duration of analgesia, defined as the time to first rescue analgesic dose. Secondary outcomes included number of rescue analgesic doses, acetaminophen usage within 24 h postoperatively, 24 h pain score area under the curve, and postoperative nausea and vomiting.Evidence reviewWe systematically searched Pubmed, Central, EMBASE, CINAHL, Google Scholar, Web of Science citation index, the US clinical trials register, and abstracts from prominent 2020–2022 anesthesia conferences for randomized controlled trials that compared these blocks and reported analgesia duration.FindingsTwelve RCTs inclusive of 825 patients were identified. TAP block was associated with longer analgesia duration (Mean difference = 1.76 h, 95% CI: 0.70–2.81, p = 0.001) and reduced doses of rescue analgesic within 24 h (Mean difference = 0.50 doses, 95% CI: 0.02–0.98, p = 0.04). No statistically significant differences were detected in other outcomes.ConclusionThis meta-analysis suggests that TAP block provides greater duration of analgesia than caudal block after pediatric surgeries. TAP block was also associated with fewer rescue analgesic doses in the first 24 h without increased pain scores.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=380876, identifier: CRD42022380876. |
| first_indexed | 2024-03-13T08:19:20Z |
| format | Article |
| id | doaj.art-149c3917be294c81a31e8e0565d5b6cd |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-03-13T08:19:20Z |
| publishDate | 2023-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-149c3917be294c81a31e8e0565d5b6cd2023-05-31T10:29:47ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602023-05-011110.3389/fped.2023.11737001173700Caudal block vs. transversus abdominis plane block for pediatric surgery: a systematic review and meta-analysisMichael Hafeman0Seth Greenspan1Emiliya Rakhamimova2Zhaosheng Jin3Robert P. Moore4Ehab Al Bizri5Department of Anesthesiology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, United StatesStony Brook University Renaissance School of Medicine, Stony Brook, NY, United StatesStony Brook University Renaissance School of Medicine, Stony Brook, NY, United StatesDepartment of Anesthesiology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, United StatesDivision of Pediatric Anesthesiology, Department of Anesthesiology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, United StatesDivision of Pediatric Anesthesiology, Department of Anesthesiology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, United StatesBackgroundThe caudal block and transversus abdominis plane block (TAP) are commonly used in combination with general anesthesia for pediatric lower abdominal, inguinal, and genitourinary surgeries. There is limited data directly comparing the impact of these techniques on recovery. In this meta-analysis, we compare the duration of postoperative analgesia between these two techniques.ObjectiveThis review examined the duration of analgesia in pediatric patients (age 0–18 years) undergoing surgery who received caudal or TAP block after induction of general anesthesia. The primary outcome was duration of analgesia, defined as the time to first rescue analgesic dose. Secondary outcomes included number of rescue analgesic doses, acetaminophen usage within 24 h postoperatively, 24 h pain score area under the curve, and postoperative nausea and vomiting.Evidence reviewWe systematically searched Pubmed, Central, EMBASE, CINAHL, Google Scholar, Web of Science citation index, the US clinical trials register, and abstracts from prominent 2020–2022 anesthesia conferences for randomized controlled trials that compared these blocks and reported analgesia duration.FindingsTwelve RCTs inclusive of 825 patients were identified. TAP block was associated with longer analgesia duration (Mean difference = 1.76 h, 95% CI: 0.70–2.81, p = 0.001) and reduced doses of rescue analgesic within 24 h (Mean difference = 0.50 doses, 95% CI: 0.02–0.98, p = 0.04). No statistically significant differences were detected in other outcomes.ConclusionThis meta-analysis suggests that TAP block provides greater duration of analgesia than caudal block after pediatric surgeries. TAP block was also associated with fewer rescue analgesic doses in the first 24 h without increased pain scores.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=380876, identifier: CRD42022380876.https://www.frontiersin.org/articles/10.3389/fped.2023.1173700/fullacute postoperative painnerve blockanesthesiacaudalpediatricsabdominal muscles |
| spellingShingle | Michael Hafeman Seth Greenspan Emiliya Rakhamimova Zhaosheng Jin Robert P. Moore Ehab Al Bizri Caudal block vs. transversus abdominis plane block for pediatric surgery: a systematic review and meta-analysis Frontiers in Pediatrics acute postoperative pain nerve block anesthesia caudal pediatrics abdominal muscles |
| title | Caudal block vs. transversus abdominis plane block for pediatric surgery: a systematic review and meta-analysis |
| title_full | Caudal block vs. transversus abdominis plane block for pediatric surgery: a systematic review and meta-analysis |
| title_fullStr | Caudal block vs. transversus abdominis plane block for pediatric surgery: a systematic review and meta-analysis |
| title_full_unstemmed | Caudal block vs. transversus abdominis plane block for pediatric surgery: a systematic review and meta-analysis |
| title_short | Caudal block vs. transversus abdominis plane block for pediatric surgery: a systematic review and meta-analysis |
| title_sort | caudal block vs transversus abdominis plane block for pediatric surgery a systematic review and meta analysis |
| topic | acute postoperative pain nerve block anesthesia caudal pediatrics abdominal muscles |
| url | https://www.frontiersin.org/articles/10.3389/fped.2023.1173700/full |
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