To compare between the intra muscular quadratous lamborum and the Trans muscular quadratous lamborum in pediatric population under going abdominal surgeries regards to first request of rescue analgesia, degree of pain relief, effect on hemo dynamic stability and incidence of complications.
The investigators hypothesized that an ultrasound guided quadratous lamborum block would prove successful peri-operative analgesia for abdominal surgeries in pediatric patients, and that Intra muscular quadratous lamborum is non inferior to Trans muscular blockade with the advantage of being safer (away from the peritoneum and retroperitoneal organs) and with the assumption that sarcolemmal layer in pediatrics should not resist the diffusion of the injectant from within the muscle out, to reach the inter fascial plane where the targeted nerves are found and cause an efficient blockade.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
DOUBLE
Enrollment
66
A 22 G echogenic needle will be inserted in plane from the posterior (medial) end of the probe and directed for the fascial plane between the Quadratus Lumborum and the Psoa Major muscles through the Quadratus Lumborum muscle. Once the needle is confirmed in correct location, 1 mL of saline will be injected after negative aspiration. Then 0.5 mL/Kg of bupivacaine 0.25% will be injected. The spread of the injectate should be observed to distribute within this plane. This technique will be repeated to the other side.
A 22 G echogenic needle will be inserted in plane from ventral (lateral) edge of the probe and advanced until penetration of QL muscle fascia is observed. Once the needle is confirmed in correct location, 1 mL of saline will be injected after negative aspiration. Then 0.5 mL/Kg of bupivacaine 0.25% will be injected. The spread of the injectate should be observed to distribute within this plane. This technique will be repeated to the other side.
Abu ElReesh hospital, Cairo university Hospital,Kasr Alini
Cairo, Egypt
Time of the first postoperative analgesic request
(duration of the block, time spent post-operative before rescue opioid is needed at pain score of 6 or higher, up to 12 hours post operative.
Time frame: starting 15 minutes post extubation, then at time intervals of 30 minutes , 60 minutes, 6 hours and 12 hours
total opioid consumption over the first 12 hours.
rescue analgesia in the form of intravenous nalbuphine 0.1 milligram/Kilogram will be given for a Wong-Baker Faces Scale more than 4 up to 12 hours post operative.
Time frame: through out the first 12 hours post operative.
Pain score up to 12 hours after surgery.
Postoperative pain score for each patient will be assessed by Wong-Baker Faces Scale at the following intervals: 15, 30, and 60 min, 6, and 12 hours after surgery.
Time frame: through out the first 12 hours post operative.
Block failure
a failed block is where the patient requires more than two doses of rescue analgesia in the first hour postoperatively
Time frame: through out the first hour post operative.
Ease of performance of each technique
Easiness of performance of the technique, rated on a simple verbal scale easy/moderately difficult/difficult) and defined as follows: * Easy block: successful block after the 1st skin puncture. * Moderately difficult block: successful block after more than one puncture or with the need for needle redirection or image optimization (as adjustment of depth, gain, or focus to visualize the needle path) * Difficult block: successful block after more than one puncture and with the with the need for needle redirection and image optimization
Time frame: through out the block performance time
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Conventional analgesia
Block performance time
Block performance time in minutes which is the time from probe contact with skin till needle withdrawal
Time frame: starting from probe contact with skin till 30 minutes.
The incidence of post block adverse effects
incidence of complications, such as: * postoperative nausea and vomiting, urinary retention, lower limb weakness * injury to the underlying structures (injury to the liver or a viscus), or hematoma formation as recorded under ultrasound guidance * need of postoperative mechanical ventilation or ICU admission * LA toxicity.
Time frame: starting after the block is given up to the first 12 hours post operative