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

Istanbul University135 enrolled

Overview

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.

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.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

SCREENING

Masking

TRIPLE

Enrollment

Conditions

Anesthesia, Local

Interventions

BupivacaineDRUG

% 0,25

Eligibility

Sex: ALLMin age: 12 MonthsMax age: 12 Years

Medical Language ↔ Plain English

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

Locations (1)

Istanbul University

Istanbul, Turkey (Türkiye)

Outcomes

Primary Outcomes

Face, Legs Activity, Cry, Consolability (FLACC) scores

It includes five categories of behavior, each scored on 0-2 point scale so that total score ranges from 0 to 10. Total scores of 0-3 is defined as mild or no pain, 4-7 as moderate, and 8-10 as severe pain.

Time frame: up to 48 hours

Secondary Outcomes

Hospital stay

Hospitalisation

Time frame: Through study completion, an average of 1 week

Number of patients who require rescue analgesic

Number of patients who require IV tramadol (1 mg/kg) at the first 2 hours and parasetamol in the 48 hours

Time frame: up to 48 hours

First analgesic requirement time

Duration of postoperative analgesia

Time frame: Up to 48 hours

Data from ClinicalTrials.gov

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