Association of Ultrasound-Guided Transversus Abdominis Plane Block With Postoperative Pain and Analgesic Requirements in Pediatric Lower Abdominal Surgery: A Retrospective Cohort Study

INTRODUCTION: Ultrasound-guided transversus abdominis plane (TAP) block is used in multimodal analgesia in pediatric abdominal surgery. We evaluated whether adding TAP block to general anesthesia was associated with postoperative pain control and reduced analgesic requirements in children undergoing lower abdominal surgery.
METHODS: We retrospectively reviewed 95 patients operated on between January 2023 and December 2025. Forty-one received ultrasound-guided TAP block in addition to general anesthesia and 54 served as controls. The primary outcome was postoperative pain intensity. Secondary outcomes included rescue analgesia, tramadol and paracetamol consumption, supplemental intraoperative fentanyl, and post-anesthesia care unit (PACU) stay.
RESULTS: Supplemental intraoperative fentanyl was lower in the TAP group (p=0.008), and additional fentanyl was required in 17.1% versus 37.0% of controls (p=0.032). PACU stay was shorter with TAP block (33.5±5.6 vs 42.2±9.1 min; p=0.001). Pain scores were lower at all postoperative assessments through 12 h (all p=0.001). Rescue analgesia within 24 h was required in 1/41 (2.4%) TAP patients versus 26/54 (48.1%) controls (p=0.001). Tramadol use, tramadol administration frequency, and 24-h paracetamol consumption were also lower in the TAP group (all p=0.001). After adjustment for age, sex, ASA physical status, surgical duration, and procedure type, TAP block remained associated with lower rescue analgesia use (adjusted OR 0.020, 95% CI 0.002–0.172; p=0.001).
DISCUSSION AND CONCLUSION: In this retrospective pediatric cohort, ultrasound-guided unilateral TAP block was associated with lower early postoperative pain scores, reduced rescue analgesia and overall analgesic use, and shorter PACU stay. TAP block may therefore be a useful component of multimodal analgesia for pediatric lower abdominal surgery.

Keywords: transversus abdominis plane block, pediatric anesthesia, lower abdominal surgery, postoperative analgesia, regional anesthesia, ultrasound guidance