Ultrasound Epidural Technique (US_epidural)

Mansoura University

Status: Completed

Conditions: Pediatric- Epidural Analgesia -Palpation-ultrasound

Treatments: Device: ultrasound

Study type: Interventional

Funder types: Other

Identifiers

NCT05331157

Ultrasound epidural

Details and patient eligibility

About

Epidural analgesia for abdominal surgeries provides numerous advantages for both neonates and children. The anatomical identification of the intervertebral space to access the epidural space is not constantly easy this is due uncertainty of the direction of the needle angle and the difficulty to estimate the epidural depth in spite of the skill of the operator. This can lead to more puncture attempts, inducing more pain or discomfort and even failure of epidural access.

Pre-procedure neuraxial ultrasound (US) imaging facilities the identification of the chosen intervertebral space, the depth of the epidural space and so the selection of best point and angle for the needle insertion

Full description

The aim of this study is to evaluate the efficacy of prepuncture ultrasonography to facilitate epidural block in pediatric patients undergoing elective urological operations compared with the conventional anatomical landmark technique

Enrollment: 110 patients

Sex: All

Ages: 1 to 12 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Pediatric patients aged from 1 to 12 years old
• Both genders
• American Society of Anesthesiologists (ASA) physical status I,II, III
• Scheduled for open midabdominal urological surgeries under general anesthesia

Exclusion criteria

• Pediatric patients aged less than 1 or more than 12 years old
• American Society of Anesthesiologists (ASA) physical status Iv
• Parents' refusal to participate in the study
• Any contraindication to epidural block (as severe infection at the puncture site, coagulopathy or hemodynamically unstable patients)
• Neuromuscular diseases
• Severe spinal deformity
• History of allergy to the anesthetic drugs

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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110 participants in 2 patient groups

palpation group

No Intervention group

Description:

In lateral decubitus position, the conventional palpation technique will be used to detect the epidural space. The midline will be identified by palpation of the spinous processes. Through the Tuffier's line, L5 spine then, the two intervertebral spaces (L3-4 and L2-3) will be detected and the middle of each intervertebral space will be marked with selection of the widest space. After sterilization of the patient's skin the needle will be inserted to detect the epidural space by using loss of resistance to saline

Ultrasonography group

Experimental group

Description:

In lateral decubitus position, a curved array probe will be utilized to scan the sacrum in the longitudinal paramedian plane, then the probe will be moved upwards to detect the L5-S1, L4-5, L3-4 and L2-3 intervertebral spaces then turned 90º to the transverse plane and used to scan L3-4 and L2-3 spaces inside the 2 spaces, midline will be detected by noting the site of spinous processes with selection of the space with the best sonographic image quality. Then skin surface at the middle of the long and short axis of the probe will be marked horizontally. If the 2 spaces have the same image quality, L2-3 space will be chosen for the entrance of epidural needle. After sterilization of the patient's skin the needle will be inserted to detect the epidural space by using loss of resistance to saline

Treatment:

Device: ultrasound