Pain, Postoperative
Conditions
Brief summary
Children can experience substantial pain after hip operations, causing agitation, depression, and sleep disruption, which can have a negative impact on their health. Opioids are associated with several serious side effects that limits its use as solo agents for pain management. Regional blocks such as caudal Block (CB) and pericapsular nerve group (PENG) block in adjuvant with general anaesthesia are alternative perioperative analgesic techniques that lead to lesser side effects, including motor weakness, postoperative nausea and vomiting with decreased opioid consumption.
Detailed description
Regional anesthesia is often used to prevent postoperative pain in pediatric surgery. Combined with general anesthesia (GA), ultrasound (US)-guided regional anesthetic approaches provide simple intraoperative pathway that reduced GA requirements, lower pain score with less impact on the respiratory or cardiovascular system In pediatric surgery, caudal block (CB) is a low-cost, simple, and effective procedure for postoperative analgesia. CB is suggested for most surgeries in the lower body, primarily below the umbilicus. Although the well-established anesthetic properties of CB, its action terminates early in the postoperative period and it has a number of restrictions, such as anatomical abnormalities or infection at the injection site, that can prevent its use PENG block is the plane lying between the psoas muscle and tendon and the ilio-pubic eminence. The single-shot PENG block has lately been reported in the cadaveric study and in the literature for perioperative pain management in hip surgery by aiming the articular arms of the accessory obturator nerve (AON), femoral nerve (FN), and obturator nerve (ON). The technical simplicity of imaging in traction-fixed patients and no need for multiple punctures made this blockage ideal for young pediatric patients. Unfortunately, there are no adequate studies regarding PENG block in patients younger than five years old. This study was carried out to assess ultrasound-guided PENG block versus CB for their efficacy, safety and pain management in pediatric hip surgery.
Interventions
PROCEDUREPericapsular Nerves Group Block
USG-guided single-shot PENG in a dose of 0.5 ml/kg of 0.25% bupivacaine per side.
PROCEDURECaudal Epidural Block
USG-guided single-shot CEB in a dose of 0.5 mL/kg of 0.25% bupivacaine.
Sponsors
Benha University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
1 Years to 7 Years
Healthy volunteers
No
Inclusion criteria
* child aged 1- 7 years old * American Society of Anesthesiologists (ASA) physical status I-II * scheduled for elective hip surgery under general anesthesia
Exclusion criteria
* parents/guardians refusal to participate * known local anesthetic drug sensitivity, * bleeding disorders, * pre-existing infection at the block site, and * the presence of major cardiac, renal, or hepatic disorders.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| pain score with FLACC | 30 minutes postoperative, 1 hour postoperative, 2 hour postoperative, and 6 hours postoperative | (Face, Legs, Activity, Cry, and Consolability scale to assess pain in young children. Each category is scored on a 0-2 scale which results in a total score between 0 (lowest pain) and 10 (worst pain). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The duration of the block | immediately after the intervention, up to 24 hours postoperative | from immediately after the block administration until the first postoperative rescue analgesia. |
| the Time to first postoperative rescue analgesia | 24 hours postoperative | it will be administered if the FLACC score is ≥ 4/10. |
| Total rescue analgesia consumption | 24 hours postoperative | total dose of Morphine administrated as rescue opioid |
| The incidence of postoperative adverse effects | 24 hours postoperative | including nausea , vomiting , localized hematoma, bradycardia, hypo-tension, and Pruritis. |
| Parents satisfaction score | 24 hours postoperative | using a 5- point Likert score (0 = very dissatisfied, 1=dissatisfied, 2 = neither satisfied nor dissatisfied, 3 = satisfied and 4 = very satisfied) |
Countries
Egypt
Outcome results
None listed