Anesthesia, Local
Conditions
Keywords
quadratus lumborum block, transversus abdominis plane block, caudal block, ultrasound-guided
Brief summary
This study evaluates analgesic effects of ultrasound-guided (USG) regional anesthetic techniques; caudal block , transversus abdominis plane (TAP) block and quadratus lumborum block (QLB) by comparing postoperative pain scores \[ Face, Legs, Activity, Cry, Consolabilty(FLACC) and Visual Analogue Scale (VAS)\], first analgesic requirement time and total analgesic consumption in pediatrics undergoing lower abdominal surgery. We also aim to observe the side effects of these techniques such as nausea, vomiting, bradycardia, hypotension, respiratory depression.
Detailed description
Lower abdominal surgeries affect dermatomes T10-L1 and blocking these nerve roots provides effective postoperative analgesia. Neuroaxial blocks such as epidural and caudal blocks is considered the gold standart regional technique for pain management after lower abdominal surgery, blocking both somatic and visceral pain. Nowadays,US is increasingly used to perform caudal block, demostrating cannule placement and precise deposition of local anesthetic in the epidural space. On the other side truncal blocks as US-guided TAP block covers T10-L1 dermatomes and provides postoperative pain relief after lower abdominal surgery with lower complication rate rather than caudal block but it may not prevent traction on the peritoneal sac. QLB is rather a new regional technique blocking nerve roots close to paravertebral area affecting somatic and visceral nerve fibers. In our study we aim to compare postoperative analgesic effects of these three techniques in paediatrics. Our primary outcomes are pain scores(FLACC/VAS) and first additional analgesic requirement time. Secondary outcomes are total analgesic consumption, side effects (nausea, vomiting, itching, urinary retention, bradycardia, hypotension, respiratory depression), length of hospitalization and chronic pain due to incision after 2 months.
Interventions
DRUGBupivacaine
% 0,25
Sponsors
Istanbul University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SCREENING
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Intervention model description
RANDOMISED DOUBLE BLINDED INTERVENTIONAL
Eligibility
Sex/Gender
ALL
Age
12 Months to 12 Years
Healthy volunteers
No
Inclusion criteria
* undergoing lower abdominal surgery * ASA(American Society of Anestesiology)1-2
Exclusion criteria
* denial of patient or parents, * infection on the local anesthetic application area * infection in central nervous system * coagulopathy * brain tumours * known allergy against local anesthetics * anatomical difficulties * with preexisting cardiac dysfunction * with history of renal and/or hepatic dysfunction
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Face, Legs Activity, Cry, Consolability (FLACC) scores | up to 48 hours | It includes five categories of behavior, each scored on 0-2 point scale so that total score ranges from 0 to 10. Total scores of 0-3 is defined as mild or no pain, 4-7 as moderate, and 8-10 as severe pain. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Hospital stay | Through study completion, an average of 1 week | Hospitalisation |
| Number of patients who require rescue analgesic | up to 48 hours | Number of patients who require IV tramadol (1 mg/kg) at the first 2 hours and parasetamol in the 48 hours |
| First analgesic requirement time | Up to 48 hours | Duration of postoperative analgesia |
Other
| Measure | Time frame | Description |
|---|---|---|
| Incidence of complications | up to first week | Hematoma, dural puncture, infections |
| Time to first mobilization | up to 48 hours | Time to first mobilization |
| Incidence of side effects | up to 48 hours | Nausea, vomiting |
Countries
Turkey (Türkiye)
Outcome results
None listed