Hip Surgery, Pericapsular Nerve, Fascia Iliaca
Conditions
Brief summary
This compares the postoperative analgesic effect of ultrasound-guided pericapsular nerve group block (PENG) with ultrasound-guided fascia iliaca compartment block in pediatric patients undergoing hip surgery.
Detailed description
Surgeries involving hip joints in pediatric patients are associated with severe intraoperative and postoperative pain despite the use of systemic opioids. Caudal block is the most commonly used method of regional anesthesia in children to control intraoperative and postoperative pain in surgeries involving lower limbs. However, there have been many side effects of caudal block such as hypotension, urine retention, excessive motor block, technical failure, nausea, and vomiting which may limit its use. There are several techniques of ultrasound-guided regional anesthesia that are used to control acute pain in hip surgery with fewer side effects such as a lumbar plexus block, femoral nerve block, or a fascia iliaca compartment block. The fascia iliaca compartment block (FICB) was described in 1989. It remains a popular regional anesthetic technique for surgical procedures involving the hip joint and femur. Local anesthetic (LA) is injected proximally beneath the fascia iliaca to block the femoral nerve (FN), obturator nerve (ON), and lateral cutaneous nerve of the thigh (LCNT) simultaneously. The pericapsular nerve group (PENG) block was introduced to block the articular branches of the femoral, obturator, and accessory obturator nerves which provide sensory innervation to the hip. This regional anesthetic technique was described in 2018 for acute analgesia related to hip fractures.
Interventions
PROCEDURECaudal Block group
Patients will be placed in the lateral decubitus position. After local sterilization with povidone-iodine, the sacral hiatus will be visualized at the level of the sacral Cornus by ultrasound. The needle will be advanced toward the upper third of the sacrococcygeal ligament. The needle advancement will be terminated immediately after penetrating the sacrococcygeal ligament. At this level, after confirming the absence of blood or cerebrospinal fluid on aspiration, bupivacaine 0.25% (0.5 mL/kg) will be injected over 1 minute
PROCEDUREPericapsular nerve group block
Patients will receive ultrasound-guided Pericapsular nerve group block in the supine position after proper sterilization of the groin region. The needle will be inserted in-plane with the transducer. The Pericapsular nerve group block group will receive 0.5 mL/kg of (0.25%) bupivacaine after a negative aspiration
PROCEDUREFascia iliaca group
Patients will receive Ultrasound-Guided fascia iliaca compartment block in the supine position after sterilization of groin area. The needle will be inserted in-plane with the transducer. The needle tip will be advanced through the fascia iliaca and inserted further cephalad just below the fascia iliaca into the iliacus muscle. 0.5 mL/kg of (0.25%) bupivacaine will be injected and visualized moving cephalad away from the needle tip
Sponsors
Tanta University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
1 Years to 6 Years
Healthy volunteers
No
Inclusion criteria
* Pediatric patients * aged 1-6 years old * both sexes, * American Society of Anesthesiologists (ASA) physical activity class I-II * scheduled for elective hip surgery under general anesthesia.
Exclusion criteria
* Children with the severe systemic disease with American Society of Anesthesiologists physical activity class III or IV. * Children with previous neurological or spinal disorders. * Coagulation disorder. * Infection at the block injection site. * History of allergy to local anesthetics.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total Opioids consumption | 24 hours postoperatively | Total Opioids consumption in first 24 hour postoperatively will be recorded |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative pain | At post anesthesia care unit then after 30 minutes 2, 4, 6, 12, 24 hours. | Postoperative pain which will be assessed by face, legs, activity, and cry consolability scale \[FLACC\] |
| Time to first rescue analgesia | 24 hours Postoperatively | Time of administration of first rescue analgesia will be recorded. |
| Adverse effects | 24 hours Postoperatively | Adverse effects: hypotension, Bradycardia, hematoma, and local anesthetic toxicity will be observed and treated accordingly. |
| Heart rate | Intraoperative then at post anesthesia care unit then after 30 minutes 2, 4, 6, 12, 24 hours | Perioperative heart rate will be observed |
| Mean arterial blood pressure | Intraoperative then at post anesthesia care unit then after 30 minutes 2, 4, 6, 12, 24 hours. | Perioperative mean arterial blood pressure will be observed |
Countries
Egypt
Contacts
Primary ContactAhmed Alam, M.B.B.CH
Outcome results
None listed