Anesthesia
Conditions
Brief summary
The use of pediatric regional anesthesia has increased because of its effective pain control, improved safety profile of local anesthetic agents, in addition to the introduction of ultra-sound. At present, caudal block is one of the most common regional anesthetic techniques employed in pediatric surgery. In addition to providing postoperative analgesia, caudal block significantly reduces intraoperative analgesic requirements and upper airway complications. Transversus abdominis plane (TAP) block involves infiltration of local anesthetics to the plane between the internal oblique and transversus abdominis muscles. Indeed, TAP block offers a hemodynamic stability, appropriate intra-operative analgesia and post surgical analgesia of the abdominal wall.
Detailed description
The use of pediatric regional anesthesia has increased because of its effective pain control, improved safety profile of local anesthetic agents, in addition to the introduction of ultra-sound. At present, caudal block is one of the most common regional anesthetic techniques employed in pediatric surgery. In addition to providing postoperative analgesia, caudal block significantly reduces intraoperative analgesic requirements and upper airway complications. However, in recent days there is a trend toward the use of peripheral nerve blockade wherever applicable, given the lower incidences of adverse effects when compared with neuron-axial techniques. Furthermore, there may be specific anatomic variations or abnormalities which preclude the use of caudal block. The abdominal wall consists of three muscular layers, the external oblique abdominis muscle (EOAM), the internal oblique abdominis muscle (IOAM), and the tranversus abdominis muscle (TAM), and their associated fascial sheaths. The central abdominal wall also includes the rectus abdominis muscles and its associated fascial sheath. This muscular wall is innervated by nerve afferents that course through the transversus abdominis neuron-fascial plane. Transversus abdominis plane (TAP) block involves infiltration of local anesthetics to the plane between the internal oblique and transversus abdominis muscles. Indeed, TAP block offers a hemodynamic stability, appropriate intra-operative analgesia and post surgical analgesia of the abdominal wall.
Interventions
PROCEDURETransversus Abdominis Plane Block
ultrasound (US) guided TAP block will be done to the patients using 0.25% bupivacaine, in a dose of (1 ml / kg).
PROCEDURECaudal Block
ultrasound (US) guided caudal block will be done to the patients using 0.25% bupivacaine, in a dose of (1 ml / kg).
Dose 1ml /kg of patient body weight
DEVICEUltra-sound guidance
using superficial high frequency probe to guide regional anesthesia
Sponsors
Zagazig University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
3 Years to 10 Years
Healthy volunteers
No
Inclusion criteria
* ASA (American society of anesthiologists) physical status grade I-II. * Operations not extending more than two hours. * Unilateral surgeries.
Exclusion criteria
* Refusal of parents. * Urgent cases. * Bilateral or Complicated hernias (i.e., obstructed, strangulated, irreducible …). * Other contraindication of regional anesthesia e.g. septic focus at site of injection, patients on anticoagulant therapy or suffering from coagulopathy, allergy to local anesthetic drug. * Prolonged operations more than two hours.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time for first analgesic request | 24 hours after surgery | by investigator till hospital discharge, then through telephone with parents after discharge |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Total Opioid consumpsion | During operation | Total amount of intra-operative fentanyl consumption. |
| Total Ibuprofen consumption | 24 hours after surgery | Total amount of oral ibuprofen consumption postoperative. |
| post operative pain score. | 2 , 4 , 8 , 12 & 24 hours after surgery. | Pain assessment by Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) by investigator till hospital discharge, then through telephone with parents after discharge |
| parents satisfaction score. | 24 hours after surgery | satisfaction were measured on a 5 point scale of extremely dissatisfied to extremely satisfied as follows: 1- Completely dissatisfied (worst), 2- Dissatisfied 3- Not satisfied, nor dissatisfied, 4- Satisfied, 5- Completely satisfied (best). |
Countries
Egypt
Contacts
Primary ContactMohammed AS Mekawy, MSc
Outcome results
None listed