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#36466 Safety and analgesic efficacy of ultrasound guided costo-transverse block in children undergoing open pyeloplasty: a case series
  1. Debesh Bhoi and
  2. Meenakshi Sundharesan A
  1. Anaesthesiology,Pain Medicine And Critical Care, All India Institute Of Medical Sciences, New Delhi, India


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Background and Aims Safe & effective perioperative analgesia is required for early recovery after open pyeloplasty surgeries. A single-shot caudal block is a widely accepted choice, however, it does not provide prolonged analgesia, and the addition of an adjuvant come with its inherent adverse effects. US- guided costo transverse block (CTB) has recently been introduced with cadaveric studies and clinical case reports, showing promising perioperative analgesia.

Methods After parental written informed consent, US-guided costo transverse block (CTB) was performed after general anesthesia (prone position) in 10 ASA I patients (mean age 3.95 yrs, weight 14.4 kg), scheduled for pyeloplasty surgery and 2mg/kg of 0.2% ropivacaine was deposited at three levels (thoracic T9-10,10,11,& 11,12). (figure1) Intraoperatively all patients received IV paracetamol and continued 6th hourly. Any pain response was not relieved by consolation and IV paracetamol was managed with fentanyl rescue(0.5mcg/kg)

Results The mean duration of surgery was 137 minutes. Intraoperatively 4 patients required fentanyl rescue. The mean time to rescue analgesic(fentanyl) not controlled by consolation and IV Paracetamol was 3 hrs, however, it was observed only in two patients. (table 1) None of the patients had any incision response. All the patients recovered well with a median FLACC on awakening 1/10 (0-2). All the patients had a good sleep with a median FLACC at 24 hours of 0/10( 0-1) and a maximum FLACC score of 4 in only one patient. (figure 2) We did not observe any procedure or local anesthetic- related complications

Abstract #36466 Figure 1

Costo-transverse block needling

Abstract #36466 Table 1

Patients demography & Perioperative analgesia

Abstract #36466 Figure 2

FLACC scale

Conclusions US-guided CTB with multimodal analgesic provides safe and effective perioperative analgesia in pediatric open pyeloplasty surgeries.

  • Costo transverse block
  • children
  • Open pyelolasty

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