Intravenous Ibuprofen Vs Ultrasound Guided Transversus Abdominis Plane Block Vs Caudal Block for Perioperative Pain Control in Lower Abdominal Surgery in Paediatrics: A Randomized Comparative Study

Background: Lower abdominal surgeries like inguinal hernia repairs are frequent pediatric procedures where effective analgesia is vital for day-case recovery. Regional anesthesia is increasingly used to reduce opioid consumption and shorten hospital stays. Objective: This study aimed to determine the effect of a single preoperative dose of intravenous ibuprofen on the time to first postoperative rescue analgesia compared to ultrasound-guided transversus abdominis plane (TAP) and caudal blocks. Methods: Seventy-five pediatric patients scheduled for lower abdominal surgery were randomly assigned to three groups (25 each): Group I (10 mg/kg IV ibuprofen), Group T (TAP block), and Group C (caudal block). Intraoperative fentanyl use, postoperative Faces, Legs, Activity, Cry, Consolability (FLACC) pain scores, and time to rescue analgesia were recorded and analyzed. Results: The time to first rescue analgesia was significantly shorter in the ibuprofen group (170 minutes) than in the TAP group (392.5 minutes) and caudal group (530 minutes) (p < 0.001). Intraoperative fentanyl requirements were significantly higher in group I (13 μg) compared to group T (2 μg) and group C (0 μg) (p < 0.001). Postoperatively, at 60 and 90 minutes, group I displayed significantly higher FLACC scores (p < 0.001) and elevated heart rates (p = 0.002 and p = 0.016, respectively) relative to the regional groups. There was no significant difference in the total amount of rescue morphine required (p = 0.102). Conclusion: Preoperative IV ibuprofen is significantly less effective than regional anesthetic techniques for perioperative pain control in pediatric lower abdominal surgery. ？