Quadratus Lumborum Block, Transversus Abdominis Plane Block, Erector Spinae Plane Block, Pediatric, Abdominal Surgery
Conditions
Brief summary
The aim of this study is to compare the analgesic efficacy and safety of Quadratus Lumborum (QL), Transversus Abdominis Plane (TAP), and Erector Spinae Plane (ESP) blocks in pediatric abdominal surgery.
Detailed description
Advances in perioperative care of children continue to be made with increasing evidence-based practice for postoperative analgesia. However, moderate to severe pain is still experienced by up to 40% of hospitalized children and specific high-risk populations or types of surgery continue to present challenges. Transversus abdominis plane (TAP) block involves the injection of local anesthesia (LA) in between the transversus abdominis (TA) and internal oblique (IO) muscles. The Erector Spinae Plane (ESP) block is most often performed using an in-plane ultrasound-guided technique. It is a paraspinal fascial plane block in which the needle placement is between the erector spinae muscle and the thoracic transverse processes, and a local anesthetic is administered, blocking the dorsal and ventral rami of the thoracic and abdominal spinal nerves.
Interventions
Patients received quadratus lumborum (QL) block with bupivacaine 0.25% (0.5 ml/kg) + dexmedetomidine 0.5 mcg/kg.
DRUGTransversus abdominis plane (TAP) block
Patients received transversus abdominis plane (TAP) block with bupivacaine 0.25% (0.5 ml/kg) + dexmedetomidine 0.5 mcg/kg.
Patients received erector spinae plane (ESP) block with bupivacaine 0.25% (0.5 ml/kg) + dexmedetomidine 0.5 mcg/kg.
Sponsors
Menoufia University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
3 Years to 12 Years
Healthy volunteers
No
Inclusion criteria
* Children aged from 3 to12 years. * Both sexes. * American Society of Anesthesiologists (ASA) Physical Status I-II. * Scheduled for pediatric abdominal surgery.
Exclusion criteria
* Allergy or contraindication to bupivacaine or dexmedetomidine. * Coagulopathy. * Local infection at the site of the block. * Neurological or psychiatric disorders affecting pain perception. * Refusal of the regional technique by parents/guardians.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Degree of pain | 24 hours postoperatively | Degree of pain will be assessed using Wong-Baker FACES for the first 24 hours postoperative at 4, 8,12,16 and 24 hours postoperatively. Wong-Baker FACES Pain Scale, which utilizes a series of 6 faces increasing in pain severity may be used to facilitate communication and assist in pain assessment . |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Total fentanyl consumption | Intraoperatively | If patient require analgesia during surgery (diagnosed by increasing heart rate and blood pressure) fentanyl 1mic/kg will be given, and total analgesic consumption will be calculated and recorded. |
| Heart rate | Till the end of surgery (Up to 2 hours) | Heart rate will be recorded every 15 minutes till the end of surgery. |
| Mean arterial blood pressure | Till the end of surgery (Up to 2 hours) | Mean arterial blood pressure will be recorded every 15 minutes till the end of surgery. |
| Time of each block | Intraoperatively | Time of each block will be recorded from using ultrasound probe till injection of local anaesthetic |
| Sedation score | 24 hours postoperatively | Sedation score will be recorded at 0, 15 min ,30 min postoperative 0=no sedation (wide awake). =slightly sedated (easy to arouse) 2=moderately sedated(easy to arouse but cannot stay awake) 3=heavy sedated (difficult to arouse) |
| Time to first rescue analgesia | 24 hours postoperatively | Time to first rescue analgesia will be recorded from the end of surgery till first dose of morphine administrated. |
| Total morphine consumption | 24 hours postoperatively | If the pain score more than or equal to 4), opioid (morphine) 0.5 to 1 mg/kg will be given and total dose will be calculated |
| Incidence of postoperative complications | 24 hours postoperatively | Incidence of postoperative complications such as hypotension, nausea and vomiting will be recorded. |
Countries
Egypt
Outcome results
None listed