Comparison of caudal epidural block versus ultrasound guided transversalis fascia plane block for perioperative analgesia in children undergoing inguinal hernia surgery – A randomized controlled study

Surgical repair of inguinal hernia is one of the most common day care surgeries in the pediatric population. Providing good analgesia is important for early mobilization and discharge from the hospital. Achieving adequate postoperative analgesia in the pediatric age group is also important in terms of future pain perception and chronic pain development in the subsequent period. Regional anaesthesia in children has become increasingly popular over the past few decades. A variety of peripheral and central nerve blocks have been developed to ensure that perioperative pain can be effectively controlled. Caudal anesthesia can be useful in the pediatric population for sub-umbilical procedures, including inguinal hernia repair, urological interventions, anal atresia repair, and lower extremity procedures. It can be stand-alone or be a supplement to general anesthesia for these procedures. Caudal analgesia in lower abdominal surgeries has become unpopular among physicians because of its short duration of analgesia (4–6) h, and its potential adverse effects including motor block, urine retention and the accidental dural puncture. Currently, fascial blocks are widely used for postoperative analgesia in patients scheduled for lower abdominal surgeries.Transversalis fascia plane block (TFB) was described by Hebbard et al. in 2009 which targets the T12 and L1 spinal nerves. In TFB the local anesthetic is deposited at the level of posterior axillary line in the layer between the transversus abdominis muscle and its deep investing transversalis fascia.The analgesic efficacy of TFP block has been demonstrated in adult surgery, including iliac crest bone graft harvesting, inguinal herniorrhaphy and cesarean section. Very few studies in literature have demonstrated the efficacy of this block in paediatric population. To our knowledge, no previous studies have compared the efficacy of this block with caudal epidural block.We have planned this study to counteract the above challenges faced during caudal and hypothesize that the analgesia coverage, intraoperative response, pain scores postoperatively in the first 12 hours in TFB will be comparable to caudal block and can be easily practiced with appropriate availability of USG and equipment.