The transversus abdominis plane (TAP) block provide a local anesthesia drug diffusion between the transverse abdominis muscle and the internal oblique muscle. TAP block reaches the anterior rami of spinal nerves from T7 to L1 involved in the innervation of homolateral abdominal wall. The transversus abdominis plane block has shown promise for perioperative analgesia, but data on the optimal dose regimen are limited.Following previous research of optimal dose of local anesthesic solution, the investigators aim to evaluate if a "volume effect" would lead to a better diffusion of the local anesthesic solution to the overall nervous roots. The local anesthesia drug choosen is levobupivacaine with a unique posology of 0,4 mg/kg (either 0,2 ml/kg of 0,2% levobupivacaine for "small volume" group or 0,4 ml/kg of 0,1% levobupivacaine for "high volume" group).With the same dose of levobupivacaine, this study aims to assess the impact of volume effect on analgesia efficiency as well as the security as after ultrasound TAP block on one to five years' old children who undergo a peritoneal-vaginal duct surgery.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Masking
SINGLE
Enrollment
70
Ultrasound guided administration of 0,2 ml/kg of 0,2% lévobupivacaine in the plane between the internal oblique and transversus abdominis muscles
Ultrasound guided administration of 0,4 ml/kg of 0,1% lévobupivacaine in the plane between the internal oblique and transversus abdominis muscles
CHU Montpellier
Montpellier, France
RECRUITINGnumber of patients for whom a rescue analgesia was necessary in post anesthesia care unit and ambulatory surgery unit
Time frame: from arrival in post anesthesia care unit until discharge (An expected average of 4 hours after end of surgery)
Intraoperative opioid consumption : total Rémifentanil (µg/kg)
Time frame: for time of surgery (1 to 4 hours)
Post operative pain (FLACC scale) at hospital
Post operative pain is evaluated every 15 minutes in the recovery room and then every two hours in the ambulatory surgical unit until discharge at home.
Time frame: from recovery room until discharge (An expected average of 4 hours after end of surgery)
Plasmatique peak of levobupivacaine (Cmax in µg/ml)
Time frame: 5 min until 75 min after injection of local anaesthetic
Time necessary to reach plasmatique peak of levobupivacaine (tmax in min)
Time frame: 5 min until 75 min after injection of local anaesthetic
Complications related to local analgesia procedure
cardiovascular adverse event, adverse vascular ponction (positive aspiration test for blood), adverse peritoneal ponction, hematoma
Time frame: until 24 hours in post operative
First request of rescue antalgic (Nubain or Tramadol)
Time frame: until 24 hours in post operative
Consommation of rescue antalgic
Time frame: until 24 hours in post operative
Pain evaluation at home by parents (score PPMP)
Time frame: call between 24 and 48 hours in post operative
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