A Comparative Study Between Combined Ketorolac Bupivacaine and Bupivacaine Alone for Transversus Abdominis Plane Block in Children Undergoing Lower Abdominal Surgeries: A Prospective Double-Blind Randomized Clinical Trial

Background: Recently, sonographic guided transversus abdominis plane (TAP) block was used in pediatrics to control postoperative pain. Our study aimed to compare the time of the first rescue analgesia between sonographic TAP block with and without ketorolac for postoperative analgesia in pediatric lower abdominal surgeries.Patients and Methods: Ipsilateral ultrasound-guided TAP block was done in ninety children who underwent elective lower abdominal operations. Patients were split into two equal groups (45 patients each): Ketorolac Group (KG) and Control Group (CG). The time of the 1st rescue analgesic dose, post-recovery 24-hour ketorolac dose, the postoperative pain score, the patients who required no rescue analgesia, adverse events, and hemodynamic effects intraoperatively and along the postoperative 24 hours, as well as parental satisfaction, were collected and analyzed.Results: The time for the first rescue analgesic dose was significantly longer in KG, and there was also significantly lower total ketorolac consumption in KG throughout the postoperative 24 hours. A significantly greater number of patients required no rescue analgesia in KG. There was a statistically significant reduction in pain scores in KG. There was also a significantly lower incidence of postoperative adverse events and more significant parent satisfaction in KG.Conclusion: Combined ketorolac and bupivacaine in a sonographic TAP block for lower abdominal surgeries in children increased the analgesic efficacy with a longer time for first rescue analgesia, less total analgesic consumption, more patients requiring no rescue analgesia, lower pain scores, fewer adverse effects, and better parent satisfaction compared to bupivacaine alone