Erector Spinae Plane Block Versus Quadratus Lumborum Block for Open Renal Surgeries in Children

Cairo University (CU)

Status and phase: Unknown; Phase 4

Conditions: Postoperative Pain, Acute

Treatments: Device: Ultrasound Machine; Drug: Fentanyl; Device: Echogenic needle; Drug: Pethidine; Procedure: Ultrasound-guided Erector Spinae Plane Block; Procedure: Ultrasound-guided Quadratus Lumborum Block

Study type: Interventional

Funder types: Other

Identifiers

NCT05386121

md-13-2022

Details and patient eligibility

About

Open renal surgeries are associated with significant postoperative pain; early control of the perioperative pain is associated with decrease of hemodynamic variations during the surgery, early mobilization, better quality of functional recovery & early discharge of patients. Side effects of systemic opioids, as well as difficulty to monitor their response, are major limitations to their use.

Pediatric regional anesthesia (PRA) is one of the most valuable and safe tools to treat perioperative pain, and is an essential part of modern anesthetic practice. Neuraxial analgesia for pediatric patients is a mode of pain control that gained popularity in the last few decades as it decreases opioid exposure, shortens recovery room time & hospital stay. Caudal block is the most commonly used neuraxial anesthesia in pediatric patients. However, its major side effect is urinary retention and excessive motor block.

Considerable progress has been made in the practice of PRA over the past few years including incorporation of ultrasound guidance, with promising novel regional anesthesia techniques, especially the anterolateral and the posterolateral trunk blocks.

In this study, the investigators will compare the ultrasound guided quadratus lumborum block (QLB) with erector spinae plane block (ESPB), regarding the duration and quality of postoperative analgesia in pediatric patients undergoing unilateral open renal surgeries under general anesthesia. The study hypothesis is that QLB can provide a more superior postoperative pain relief to ESPB in children undergoing open renal surgeries.

Enrollment: 60 estimated patients

Sex: All

Ages: 1 to 6 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

1. American society of anesthesiologists (ASA) class I and II
2. Children undergoing unilateral open renal surgeries

Exclusion criteria

1. Parents refusal for the block
2. Bleeding disorders (platelets count < 100,000/uL; INR > 1.5; PC < 60%)
3. Skin lesion, wounds or infection at the puncture site.
4. Known allergy to local anesthetic drugs

Trial design

Primary purpose: Other

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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60 participants in 2 patient groups

Erector spinae plane block (ESPB) group

Active Comparator group

Description:

30 child will receive a preoperative unilateral single shot US-guided erector spinae plane block at the level of T9 vertebra in the lateral position after induction of general anesthesia, using 0.5 mL/kg of bupivacaine 0.125%

Treatment:

Device: Echogenic needle

Drug: Fentanyl

Device: Ultrasound Machine

Procedure: Ultrasound-guided Erector Spinae Plane Block

Drug: Pethidine

Quadratus lumborum block (QLB) group

Active Comparator group

Description:

30 child will receive a preoperative unilateral single shot US-guided quadratus lumborum block at the level of L2 spinous process in the lateral position after induction of general anesthesia, using 0.5 mL/kg of bupivacaine 0.125%

Treatment:

Procedure: Ultrasound-guided Quadratus Lumborum Block

Device: Echogenic needle

Drug: Fentanyl

Device: Ultrasound Machine

Drug: Pethidine