Comparing Postoperative Analgesic Techniques for Umbilical Hernia Repair: A Randomized Trial of Ultrasound Guided Caudal, Erector Spinae, and External Oblique Interfascial Plane Blocks

Tanta University

Status: Invitation-only

Conditions: Regional Anesthesia

Treatments: Other: Erector Spinae Plane Block; Other: External Oblique Intercostal Plane Block; Other: Caudal Block Anesthesia

Study type: Interventional

Funder types: Other

Identifiers

NCT06948253

36264PR1119/3/25

Details and patient eligibility

About

The aim of this study is to evaluate the efficacy of ultrasound guided Erector block versus caudal block versus external oblique intercostal plane block perioperatively

Full description

umblical hernia repair surgeries have been performed in the practice of pediatric surgeries, ensuring adequate perioperative analgesia is crucial for perioperative care as pain in pediatric patients can cause functional recuperation and lead to negative behavioral changes and family dissatisfaction. (1) Various studies are made to improve postoperative analgesia and facilitate recovery in pediatric patients.(1) Day-case surgery is defined as the planned day admission of a patient to hospital for a surgical procedure, after which there is subsequent successful and safe discharge back home on the same day in a safe and timely manner instead of spending prolonged periods within the hospital.(2) This has significant implications, including reducing hospital stay, hospital-acquired infection, and healthcare-related costs while also improving patient experience and service efficiency. Surgical, anesthetic, and patient factors should be considered for successful day case surgery.(2) External oblique intercostal plane block (EOIPB) is a novel fascial plane block which aims to provide upper midline and lateral abdominal wall analgesia thereby reducing perioperative opioid consumption , LA is deposited into the fascial plane beneath the external oblique muscle (EOM) and superficial to the sixth rib or external intercostal muscle. It targets anterior and lateral cutaneous branches of the thoracoabdominal nerves from the ventral rami of spinal nerves.(3)

Caudal block is the most frequently performed regional technique for pain management in children undergoing lower abdominal surgeries. Ultrasound guidance has resulted in enhanced reliability and safety profiles for caudal blocks.(4) The erector spinae plane block (ESPB), multiple studies demonstrated its potential as a practical approach for managing postoperative pain in the last decade, involves an ultrasound-guided injection of a relatively large volume of local anesthetic into the fascial plane beneath the erector spinae muscle. (5)

Enrollment: 75 estimated patients

Sex: All

Ages: 2 to 7 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• pediatric patients of both sexes undergoing elective umblical hernia surgeries aged from 2 year to 7 years belonging to ASA I or II.

Exclusion criteria

• Parents refusal.
• Coagulopathy.
• Allergy to local anesthesia.
• Local infection at the site of injection.
• Neurological anomalies.

Trial design

Primary purpose: Other

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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75 participants in 3 patient groups

Group E

Active Comparator group

Description:

Erector spinae plain block group will receive 0.5 ml/kg of 0.25%bupivacaine bilaterally

Treatment:

Other: External Oblique Intercostal Plane Block

Group C

Active Comparator group

Description:

Caudal block group will receive 1 ml/kg of 0.25% bupivacaine.

Treatment:

Other: Caudal Block Anesthesia

Group EOI

Active Comparator group

Description:

External oblique intercostal block will recive 0.5 ml/kg 0.25 % bupivacaine bilaterally.

Treatment:

Other: Erector Spinae Plane Block