Analgesic efficacy of ultrasound-guided modified thoracoabdominal nerve block in paediatric upper abdominal surgery: A randomised controlled trial.

Background and aims: Adequate pain management is crucial for postoperative recovery in paediatric patients. This study aimed to evaluate the analgesic efficacy of ultrasound (US)-guided modified thoracoabdominal nerve block through perichondrial approach (mTAPA) block in paediatric patients undergoing upper abdominal surgeries.

Methods: This randomised controlled trial included 40 paediatric patients aged between 2 and 8 years scheduled for unilateral upper abdominal surgeries. Patients were randomised into two groups: Group I received general anaesthesia (GA) with US-guided mTAPA block (0.5 mL/kg of 0.2% ropivacaine), while Group II received GA only. Intravenous fentanyl 0.5 µg/kg was utilised for perioperative pain management. The primary outcome was to assess intraoperative opioid consumption, whereas secondary outcomes were postoperative pain scores, 24-h opioid consumption, and adverse effects such as nausea and vomiting. The independent Student t-test compared quantitative, normally distributed data, while the Mann-Whitney U test compared quantitative, discrete data. A P value of <0.05 was considered statistically significant.

Results: Patients in Group I had a statistically lower intraoperative median fentanyl consumption of 10.0 µg [range: 0-20, interquartile range (IQR): 0-10] versus 20 µg (range: 5-48, IQR: 20-27) in Group II (P = 0.001). There was a significant reduction in the number of patients requiring rescue opioid top-ups (32.5% vs 50%) and postoperative pain scores (till 16 hours) in Group I. The median time to rescue analgesia was significantly higher in Group I than Group II (P = 0.001). No significant side effects were observed in either group.

Conclusion: Ultrasound-guided modified thoracoabdominal nerve block through perichondrial approach as an adjunct to general anaesthesia provides effective analgesia by significantly reducing opioid consumption in paediatric patients undergoing upper abdominal surgeries through a unilateral subcostal incision.