Comparing Analgesic Effects of Three Ultrasound Guided Regional Anesthetic Techniques in Pediatrics

Istanbul University

Status: Completed

Conditions: Anesthesia, Local

Treatments: Drug: Bupivacaine

Study type: Interventional

Funder types: Other

Identifiers

NCT03780790

2018/1076

Details and patient eligibility

About

This study evaluates analgesic effects of ultrasound-guided (USG) regional anesthetic techniques; caudal block , transversus abdominis plane (TAP) block and quadratus lumborum block (QLB) by comparing postoperative pain scores [ Face, Legs, Activity, Cry, Consolabilty(FLACC) and Visual Analogue Scale (VAS)], first analgesic requirement time and total analgesic consumption in pediatrics undergoing lower abdominal surgery. We also aim to observe the side effects of these techniques such as nausea, vomiting, bradycardia, hypotension, respiratory depression.

Full description

Lower abdominal surgeries affect dermatomes T10-L1 and blocking these nerve roots provides effective postoperative analgesia. Neuroaxial blocks such as epidural and caudal blocks is considered the gold standart regional technique for pain management after lower abdominal surgery, blocking both somatic and visceral pain. Nowadays,US is increasingly used to perform caudal block, demostrating cannule placement and precise deposition of local anesthetic in the epidural space. On the other side truncal blocks as US-guided TAP block covers T10-L1 dermatomes and provides postoperative pain relief after lower abdominal surgery with lower complication rate rather than caudal block but it may not prevent traction on the peritoneal sac. QLB is rather a new regional technique blocking nerve roots close to paravertebral area affecting somatic and visceral nerve fibers. In our study we aim to compare postoperative analgesic effects of these three techniques in paediatrics. Our primary outcomes are pain scores(FLACC/VAS) and first additional analgesic requirement time. Secondary outcomes are total analgesic consumption, side effects (nausea, vomiting, itching, urinary retention, bradycardia, hypotension, respiratory depression), length of hospitalization and chronic pain due to incision after 2 months.

Enrollment: 135 patients

Sex: All

Ages: 12 months to 12 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• undergoing lower abdominal surgery
• ASA(American Society of Anestesiology)1-2

Exclusion criteria

• denial of patient or parents,
• infection on the local anesthetic application area
• infection in central nervous system
• coagulopathy
• brain tumours
• known allergy against local anesthetics
• anatomical difficulties
• with preexisting cardiac dysfunction
• with history of renal and/or hepatic dysfunction

Trial design

Primary purpose: Screening

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Triple Blind

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135 participants in 3 patient groups

Quadratus Lumborum Block

Active Comparator group

Description:

US-guided quadratus lumborum block will be performed with 0,5 ml/kg 0.25% Bupivacaine in the anterior layer of the thoracolumbar fascia between psoas major and quadratus lumborum muscles

Treatment:

Drug: Bupivacaine

Transversus Abdominis Plane Block

Active Comparator group

Description:

US- guided transversus abdominis plane block will be performed with 0,5 ml/kg 0.25% Bupivacaine into the fascial plane between internal oblique muscle and transversus abdominis muscle

Treatment:

Drug: Bupivacaine

Caudal Block

Active Comparator group

Description:

US-guided caudal epidural block will be applied to 0.7 ml/kg 0.25 % Bupivacaine up to a maximum of 20 mL

Treatment:

Drug: Bupivacaine