Hip Dislocation, Congenital, Postoperative Pain, Anesthesia
Conditions
Keywords
hip dislocation, regional anesthesia, surgery
Brief summary
Caudal blockade (CB) is one of the most frequently performed regional anaesthetic techniques in children. It's an efficient way to offer perioperative analgesia for painful sub-umbilical interventions but with high incidence of motor block and urinary retention. In one study, psoas compartment block was associated with less morphine comsumption and prolonged duration of analgesia compared to single-shot caudal Block in small children undergoing open hip reduction/osteotomies. Ultasound guided anterior Quadratus lumborum block (AQLB) provides unilateral analgesia to the nerves between the psoas muscle (PM) and the quadratus lumborum muscle (QLM). The first pediatric study evaluating Quadratus lumborum block is encouraging . The first pediatric study evaluating Quadratus lumborum block is encouraging. To the best of the investigator's knowledge, there are no previously published data comparing the AQLB with other regional techniques in infants undergoing hip surgery.
Detailed description
The aim of this prospective randomized study was to compare the analgesic effects between AQLB and CB in children undergoing unilateral open hip reduction/osteotomies for hip dislocation. Patients were randomly assigned, into 1 of 2 groups, namely, group CB (n = 20) and group AQLB (n = 20). Preoperatively all children were premedicated by using oral midazolam (0 .5mg/kg). anesthesia was induced with 3 to 4% sevoflurane and 50% with 60% nitrous oxide in oxygen.Then fentanyl 3 μg/kg and Propofol 1 - 2mg/Kg were administered for anesthesia induction. Airway was secured with endotracheal tube placed in the mouth facilited by 0.15 mg/kg cistracurium. Anesthesia maintenance was performed with sevoflurane 2% in 50% nitrous oxide. AQLB and CB were done with 1 ml/kg, 0.25% Ropivacaine (maximum dose limited to 20 ml) Postoperative follow-up: All patients received 15 mg/kg paracetamol before extubation. Tramadol 2 mg/kg intravenous was planned as rescue analgesia when CHEOPS score was more than 3. Supplemental IV tramado, 1 mg/kg could be added if necessary every 6 hours.
Interventions
PROCEDUREanterior Quadratus lumborum block
ultrasound anterior quadratum lumborum block with 1 ml/kg 0.2% ropivacaine
PROCEDUREcaudal block
ultrasound guided caudal block with 1 ml/kg 0.2% ropivacaine
Sponsors
Institut Kassab d'Orthopédie
University Tunis El Manar
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
2 Years to 7 Years
Healthy volunteers
No
Inclusion criteria
* Patients aged 2 to 7 years old * Weight ≤ 20 Kg * American Society of Anesthesiologists (ASA) physical status I or II * Planned to undergo unilateral open hip reduction/osteotomies
Exclusion criteria
* Cerebral palsy with severe intellectual disability * Coagulation disorders * Local or general infection * Allergy to amide local anesthetics. * Progressive neurological disorders * Parenteral refusal * Spinal dysraphism * Cutaneous anomalies (angioma, hair truft, naevus or a dimple)near to the puncture
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| analgesics consumption | day one | total tramadol consumption |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| postoperative pain score | day one | Children's Hospital Eastern Ontario Pain Scale (CHEOPS) \[4=no pain ; 13=worst pain\] |
| analgesic rescue | Day one | time to first analgesic rescue |
Countries
Tunisia
Outcome results
None listed