Oğuz Kağan BULUT, Sevim Şenol KARATAŞ, Sait Fatih ÖNER
Eastern Journal of Medicine (EJM) - 2026;31(4):815-825
Ultrasound-guided transversus abdominis plane (TAP) block is increasingly incorporated into multimodal analgesic protocols for children undergoing abdominal procedures. We investigated whether adding a TAP block to general anesthesia was associated with improved postoperative pain control and reduced analgesic use in pediatric patients undergoing lower abdominal surgery. We retrospectively reviewed pediatric lower abdominal operations performed from January 2023 through December 2025. Ninety-five patients fulfilled the predefined eligibility criteria and constituted the study cohort. Of these, 41 received an ultrasound-guided TAP block in addition to general anesthesia, whereas 54 were managed without the block. Postoperative pain intensity was the primary endpoint. Other evaluated outcomes were the need for rescue analgesia, cumulative tramadol and paracetamol use, additional fentanyl administration during surgery, and time spent in the post-anesthesia care unit (PACU). Baseline demographic and operative characteristics did not differ significantly between the two groups. Patients receiving TAP block required less supplemental intraoperative fentanyl (p=0.008), and the proportion requiring an additional fentanyl dose was 17.1% compared with 37.0% among controls (p=0.032). Recovery in the PACU was faster in the TAP group, with a mean stay of 33.5+/-5.6 minutes versus 42.2+/-9.1 minutes in the control group (p=0.001). Across every recorded postoperative assessment through hour 12, pain scores favored the TAP group (all p=0.001). During the first 24 hours, rescue analgesia was administered to 1 of 41 patients (2.4%) who received TAP block and to 26 of 54 patients (48.1%) in the control group (p=0.001). Cumulative tramadol use, frequency of tramadol administration, and 24-hour paracetamol consumption were likewise reduced in the TAP group (all p=0.001). After adjustment for age, sex, ASA physical status, surgical duration, and procedure type, receipt of TAP block remained strongly associated with a lower probability of rescue analgesia use within 24 hours (adjusted OR 0.020, 95% CI 0.002-0.172; p=0.001). In this retrospective pediatric cohort, incorporating a unilateral ultrasound-guided TAP block into the anesthetic regimen was associated with better early postoperative pain control, substantially less need for rescue medication, lower overall analgesic exposure, and a shorter PACU stay. These results suggest that TAP block can provide meaningful analgesic benefit as part of a multimodal strategy for pediatric lower abdominal procedures.
