SUMMARY

                Although abdominal laparoscopic surgery is known for less pain compared to that of laparotomy, many patients actually still complain of considerable postoperative pain. Pain after laparoscopic surgeries is caused by the incision and visceroperitoneal pain due to peritoneal stretch and inflammation. A promising approach to the provision of postoperative analgesia after abdominal surgery is to block the sensory nerve supply to the anterior abdominal wall by placing a local anaesthetic in the transversus abdominis plane. The TAP block was first described by McDonell and colleagues in 2004 and a USG guided technique was subsequently described by Hebbard and colleagues. USG guided TAP block provides excellent pain relief in lower abdominal surgeries. The purpose of this study is to evaluate the analgesic efficacy of USG guided TAP block in children undergoing laparoscopic surgeries.

                  After obtaining ethical clearance from the institutional review board, the study will be carried out in 72 patients posted for laparoscopic surgeries like hernia repair, orchidopexy, appendicectomy and cholecystectomy in Paediatric Surgery OT. The patients will be divided into two groups after induction of anaesthesia:

Group A: Patients will receive bilateral TAP block under USG guidance using 0.4ml/kg 0.25% Inj. Bupivacaine.

Group B: Patients will receive local infiltration at the port using 0.4ml/kg 0.25% Inj. Bupivacaine.

Inj Paracetamol 15mg/kg will be given intravenously in both groups at the beginning of surgery. Parameters recorded will be: Intraoperatively hemodynamics i.e. heart rate and blood pressure monitoring every 15minutes and total dose of opioid required. Postoperatively assessment of pain: Wong Baker FACES scale, duration of analgesia and adverse effects. The pain score will be assessed at 10min, 30mins, 1hour and hourly thereafter up to 6 hours post operatively. Inj. Diclofenac 1.5mg/kg will be given as rescue analgesic post operatively if the Wong Baker’s FACES score is more than 4.

Statistical analysis: Statistical analysis of the demographic data will be done using Chi-square test. The continuous outcomes will be measured using the Student’s t test or the Mann Whitney U test. A p value<0.05 will be considered significant.