Analgesia, Postoperative
Conditions
Keywords
postoperative analgesia, ultrasound guided paravertebral block, ultrasound guided erector spinae plane block, inguinal hernia repair in pediatric
Brief summary
The aim of the study is to compare postoperative analgesia in pediatric patients undergoing inguinal hernia repair by comparing the efficacy of ultrasound guided paravertebral block versus ultrasound guided erector spinae plane block.
Detailed description
* To assess the total amount of rescue analgesic consumption in the first 24 hours post-operatively in each group. * To measure the time of first request of rescue analgesia and to assess pain intensity at rest (static) and after movement or coughing (dynamic) using 10 points Modified Objective Pain Score (MOPS). * To record the incidence of complications (hematoma, local anesthetic toxicity, pneumothorax, infection, hypotension, epidural or intrathecal spread). * Over all parent's satisfaction: The parents will be asked to rate the overall degree of satisfaction of the analgesia by using a 5-points likert-like verbal scale (1 = very dissatisfied analgesia, 2 = dissatisfied analgesia, and 3 = neutral, 4=satisfied analgesia, and 5=very satisfied analgesia).
Interventions
after sterilization and identifying the level of T10 ,linear ultrasound probe will be placed in the midline over the spinous process at the chosen level, then the probe will be moved laterally to view the lamina and hyperechoic transverse process ,the pleural should be visible as a bright white line .The needle should be inserted in -plane from lateral to medial and the needle tip should end in a hypoechoic triangular space. Correct needle placement should be confirmed by anterior displacement of pleura with injection of small volume of saline then 0.5 ml/kg of a mixture of 0.25 ℅ bupivacaine and 1℅ lidocaine (1:1) will be injected
After sterilization, the linear ultrasound probe will be placed over transverse process of T10 ,after optimizing the image in sagittal or transverse scanning ,A 50 mm 22-G needle will be placed under the erector spinae muscle in -in plane orientation until it contacted T8 transverse process in the cranial caudal direction ,after hydro dissection and confirmation that the tip of the needle is between the transverse process and the fascia of the erector spinae muscle group, 0.5 ml/kg of a mixture of 0.25 ℅bupivacaine and 1℅ lidocaine (1:1) will be injected
PROCEDUREcontrol group C
will receive standard general anesthesia with pain management protocol without regional block.
Sponsors
Zagazig University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Masking description
anesthetist not sharing in the study will assess patients
Intervention model description
Postoperative analgesia after inguinal hernia repair in pediatric by ultrasound guided paravertebral block or erector spinae block
Eligibility
Sex/Gender
ALL
Age
24 Months to 12 Years
Healthy volunteers
Yes
Inclusion criteria
1 - Parents acceptance 2\. Age: preschool and school age child (24 months-12 years old). 3\. Sex: both sex (males or females). 4\. Physical status: ASA 1& II. 5\. Type of operation: elective unilateral inguinal hernia repair
Exclusion criteria
1- Patient with any contraindications of regional blocks (as coagulopathy or local infection at injection site) 2\. Patients with known history of allergy to the study drugs (bupivacaine and lidocaine). 3\. Advanced hepatic, renal, cardiovascular, neurologic and respiratory diseases.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The total amount of rescue analgesia (Ibuprofen consumption) | for 24 hours postoperative | The total consumption of rescue analgesia (Ibuprofen consumption) postoperative |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pain intensity at rest (static) and after movement or coughing (dynamic) | 0 minutes immediate postoperative ( on arrival to PACU), 30 minutes, 1hs, 2hs, 4hs, 8hs, 12 hrs and 24hs postoperatively | by using 10 points Modified Objective Pain Score (MOPS)(0=no pain, 1-3=mild pain, 4-6=moderate pain, and 7-10= sever pain) |
| The time to first request of rescue analgesia (Ibuprofen) | for 24 hours postoperative | the time from giving block till time of first request of ibuprofen when MOPS \> 3 at rest or after movement |
| The total number of patients requiring additional dose of intraoperative fentanyl. | during operation period | Number of patients receive additional dose of intra operative fentanyl ( increase in the mean blood pressure or heart rate 20% above base line readings, fentanyl in a dose 0.5 mcg/kg will be given to the patient) |
| To record the incidence of complications | 24 hours postoperative | To record the incidence of complications (hematoma, local anesthetic toxicity, pneumothorax, infection, hypotension, epidural or intrathecal spread) |
| Over all parent's satisfaction | 24 hours postoperative | The parents will be asked to rate the overall degree of satisfaction of the analgesia by using a 5-points likert-like verbal scale (1 = very dissatisfied analgesia, 2 = dissatisfied analgesia, and 3 = neutral, 4=satisfied analgesia, and 5=very satisfied analgesia) |
Countries
Egypt
Contacts
Primary ContactDina Sadek Salem, MD
Backup ContactFatima Ahmed, MD
Outcome results
None listed