Bakshi Sumitra G, Doctor Jeson R, Trivedi Bhakti D, Qureshi Sajid S
Department of Anesthesiology, Critical Care, Tata Memorial Hospital, Mumbai, Maharashtra, India.
Department of Pain and Paediatric Surgery, Tata Memorial Hospital, Mumbai, Maharashtra, India.
J Anaesthesiol Clin Pharmacol. 2017 Jan-Mar;33(1):121-122. doi: 10.4103/0970-9185.202187.
Regional techniques provides excellent post operative pain relief in pediatric patients. Transversus abdominis plane (TAP) block is a newer regional technique available. Though there is emerging evidence proving the efficacy of TAP blocks, there is limited literature on use of TAP catheters in pediatric patients. TAP catheters were placed in two children following laparotomy with transverse incisions and in both epidural was avoided, with good post operative pain relief. Ultrasound guidance was used in one child, while in the other the catheter was placed under direct vision after dissection of the plane between transversus abdominis and internal oblique. Intermittent boluses of high volumes of local anesthetic (0.6-0.7 ml/kg) were used through the TAP catheter, ensuring that the maximum permissible level of bupivacaine was not exceeded. In adults, continuous abdominal catheters have found a place for post-operative pain management, when epidural analgesia is contraindicated. At present, the use of TAP catheters by pediatric anesthesiologists is limited, though there exists diverse clinical scenarios when these catheters may be of benefit. Contraindication of neuraxial blockade and septic patients are the two scenarios we have reported. In conclusion, TAP catheters are effective analgesia technique for laparotomies with transverse incision in pediatric patients.
区域技术能为小儿患者提供出色的术后疼痛缓解。腹横肌平面（TAP）阻滞是一种新的区域技术。尽管越来越多的证据证明TAP阻滞的有效性，但关于小儿患者使用TAP导管的文献有限。在两名接受横向切口剖腹手术的儿童中放置了TAP导管，且均未采用硬膜外麻醉，术后疼痛缓解良好。其中一名儿童使用了超声引导，另一名儿童在解剖腹横肌和腹内斜肌之间的平面后在直视下放置了导管。通过TAP导管间歇性推注大量局部麻醉剂（0.6 - 0.7 ml/kg），确保不超过布比卡因的最大允许剂量。在成人中，当硬膜外镇痛禁忌时，连续腹部导管已在术后疼痛管理中占有一席之地。目前，小儿麻醉医生对TAP导管的使用有限，尽管在多种临床情况下这些导管可能有益。我们报告了神经轴阻滞禁忌和脓毒症患者这两种情况。总之，TAP导管是小儿患者横向切口剖腹手术有效的镇痛技术。
