Pain, Postoperative
Conditions
Brief summary
Caudal analgesia along with general anesthesia is a very popular regional technique for prolonged postoperative analgesia in different pediatric surgical procedures where the surgical site is sub-umbilical. Caudal anesthetics usually provide analgesia for approximately 4-6 hours. Recently, the use of spinal anesthesia in infants and children requiring surgeries of sub-umbilical region is gaining considerable popularity worldwide. \- The ease of performance and the safety regarding cardio-respiratory functions makes spinal anesthesia as an alternative to general anesthesia in infants and children undergoing surgeries of sub-umbilical regions.
Detailed description
The historic view that young children neither respond to, nor remember, painful experiences to the same degree as adults is no longer thought to be true. About 40% of pediatric surgical patients experienced moderate or severe postoperative pain and 75% had insufficient analgesia. -Pediatric acute pain services use techniques of concurrent or co-analgesia based on four classes of analgesics, namely local anesthetics, opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and acetaminophen (paracetamol). Caudal analgesia along with general anesthesia is a very popular regional technique for prolonged postoperative analgesia in different pediatric surgical procedures where the surgical site is sub-umbilical. Caudal anesthetics usually provide analgesia for approximately 4-6 hours. Recently, the use of spinal anesthesia in infants and children requiring surgeries of sub-umbilical region is gaining considerable popularity worldwide. \- The ease of performance and the safety regarding cardio-respiratory functions makes spinal anesthesia as an alternative to general anesthesia in infants and children undergoing surgeries of sub-umbilical regions.
Interventions
DRUGIntrathecal hyperbaric bupivacaine 0.25mg/kg 0.5%
The lumber puncture will be made in the lateral position at the L4-5 or L5-S1 interspace with a 25 G pencil point Quincke spinal needle with a short bevel and the orifice of the spinal needle will be turned cephalad.
DRUGcaudal plain bupivacaine 2.5mg/kg 0.25%
The sacral hiatus between the sacral conru will be palpated. While inserting the 23-G needle at 45° to the skin in the midline, a distance give or pop will be felt as the needle passes the sacral ligament into the caudal space, the needle will be tilted more toward the skin surface and inserted 2-3mm deeper.
Sponsors
Assiut University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Caregiver, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
2 Years to 12 Years
Healthy volunteers
No
Inclusion criteria
* Age: 2-12 years. * Weight: 15-40 kg. * Sex: both males and females. * ASA physical status: 1-II. * Operation: surgery below umbilicus.
Exclusion criteria
* Allergic reaction to local anesthetics (LAs). * Local or systemic infection (risk of meningitis). * Coagulopathy. * Intracranial hypertension. * Hydrocephalus. * Intracranial hemorrhage. * Parental refusal. * Hypovolemia. * Spinal deformities, such as spina bifida or myelomeningocele. * Presence of a ventriculoperitoneal shunt because of a risk of shunt infection or dural leak.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| FLACC Score | 24 hours | FLACC scores will be recorded. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Total consumption of rescue analgesics | 24 hours | The total consumption of postoperative rescue analgesics will be recorded. |
| Postoperative Agitation | 60 min. | Postoperative agitation will be evaluated by the Four Point Agitation Sedation scale. |
| Adverse effects | 24 hours | Any adverse effect will be treated and recorded. |
| Residual motor paralysis | 6 hours | By the Modified Bromage scale |
Countries
Egypt
Outcome results
None listed