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226 USG guided tap block for post operative analgesia in children with COVID infection undergoing laparotomy
  1. A Praniarda
  1. Brawijaya University, Malang, Indonesia


Background and Aims The COVID-19 infection that broke out in the past year had a major impact on pediatric surgery. The urgency of surgical management and asymptomatic symptom in pediatric patients to the risk of multiorgan inflammatory syndrome makes anesthesiologists consider safe and optimal anesthetic techniques.

Methods 9-year-old with 18 kg bodyweight was complained of abdominal pain, diagnose with peritonitis and planned for laparotomy. Patients underwent with general anesthesia intubation. Drugs for induction include fentanyl 40mcg, ketamine 20 mg, and atracurium 10 mg intravenously. Hemodynamics during surgery was stable and after surgery, the patient performed TAP block of Ropivacaine 0.2% and Clonidine 30mcg with total volume 5 ml each side for post operative analgesia.

Results Patient was operated in COVID-19 operating room which intubation use aerosol box to prevent aerosol contacted to operating room personnel. Maintenance with isoflurane and after surgery risk of pain score of 5–7 so the patient performed Transversus Abdominis Block of 0.2% ropivacaine and Clonidine 30mcg with 5 ml for each side. Transversus abdominis plane block is a regional technique, ultrasound guidance has increased the safety and efficacy of blocks. Ultrasonography allows real-time visualization of anatomical structures, guides the blocking procedure, and shows the spread of the local anaesthetic solution. A more rapid onset of block using less local anaesthetic solution is particularly attractive for paediatrics where most blocks are sited in anaesthetized patients.

Conclusions Intraoperative management including induction, intubation, and extubation should be considered to reduce viral exposure. Postoperative management includes optimal hemodynamic and adequate analgesic monitoring. Regional techniques provide excellent postoperative analgesia in pediatric.

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