Pain Postoperative
Conditions
Brief summary
Although scalp nerve blocks have been shown to provide effective postoperative analgesia in pediatric neurosurgical procedures, limited data exist on their use under ultrasound guidance. The smaller anatomical structures and higher vascularity of the pediatric scalp increase the risk of inadvertent vessel puncture or systemic toxicity with landmark-based techniques. Ultrasound guidance enables direct visualization of the targeted nerves and adjacent vessels, potentially improving block accuracy and safety. To date, no randomized controlled trial has compared ultrasound-guided versus conventional scalp block specifically in pediatric supratentorial tumor surgeries. This study aims to fill this gap.
Interventions
PROCEDUREUltrasound-guided scalp block
Patients will receive ultrasound-guided scalp block using bupivacaine 0.25% at 0.1-0.2 mL/kg per nerve site, not exceeding a total dose of 2.5 mg/kg.
PROCEDUREconventional scalp block
Patients will receive conventional scalp block using landmark-based technique with bupivacaine 0.25% at 0.1-0.2 mL/kg per nerve site, not exceeding a total dose of 2.5 mg/kg.
Sponsors
Cairo University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
2 Years to 12 Years
Healthy volunteers
No
Inclusion criteria
* American Society of Anesthesiologists (ASA) physical status I, II. * Undergoing elective supratentorial tumor surgery under general anesthesia on one side of the head.
Exclusion criteria
* Urgent/emergency craniotomy. * Coagulopathy or platelet dysfunction. * Allergy to local anesthetics. * Pre-existing bradycardia (HR \<60 bpm in infants, \<50 bpm in older children) or unstable arrhythmias. * Severe hepatic/renal impairment.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Mean arterial blood pressure intraoperatively from baseline till skin incision | from 5 minutes immediately before skin incision till the peak mean arterial blood pressure recorded within the first minute after incision | The mean arterial blood pressure recorded during 5 minutes immediately before skin incision till the peak mean arterial blood pressure recorded within the first minute after incision |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Duration of analgesia | 24 hours postoperatively | The time to the first postoperative analgesic request |
| objective pain scale | 2, 4, 6, 8, 12, 16, and 24 hours postoperatively | objective pain scale is based on 5 criteria: (1) systolic arterial blood pressure, (2) crying, (3) movement, (4) agitation, and (5) verbal evaluation (complaint of pain). Each criterion is allocated a score of 0 to 2 (2 being the worst), giving a minimum OPS score of 0 and the maximum possible score of 10; the worst OPS score is 10 if the child is old enough to complain of pain and 8 if the child is too young to complain of pain |
| Total doses of ketorolac | 24 hours postoperatively | — |
| 6. Total dose of paracetamol | 24 hours postoperatively | — |
Outcome results
None listed