This study will be conducted to compare the efficacy and safety of ultrasound guided erector spinae block , ultrasound guided caudal block and conventional caudal block for pain management after pediatric hip surgery.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
105
Patients of this group will receive (0.5ml/kg) (plain bupivacaine 0.25% injected in the caudal epidural space) by the conventional method (blind technique without ultrasound).
Using ultrasound, patients of this group will receive (0.5ml/kg) (plain bupivacaine 0.25% injected in the caudal epidural space).
Under ultrasound guidance, patients of this group will receive (0.5ml/kg) (plain bupivacaine 0.25% injected beneath the erector spinae muscle sheath) at the level of the transverse process of the second lumbar vertebrae(L2).
Tanta University Hospitals
Tanta, ElGharbiaa, Egypt
RECRUITINGDegree of pain intensity
To evaluate the pain scores by (FLACC) scale. (FLACC) scale will be assessed after surgery over 24 hours where (0 = Relaxed and comfortable, 1-3 = Mild discomfort, 4-6 = Moderate pain ,7-10 = Severe discomfort /pain)
Time frame: First 24 hours postoperative
Changes in mean arterial blood pressure
Mean arterial blood pressure will be recorded before block performance at T0, intraoperatively at 15 and 30 minutes, then every 30 min till the end of surgery and after surgery at T (0, 2, 4, 6, 12, 24 h).
Time frame: Intraoperative and first 24 hours postoperative
Changes in heart rate
Heart rate will be recorded before block performance at T0, intraoperatively at 15 and 30 minutes, then every 30 min till the end of surgery and after surgery at T (0, 2, 4, 6, 12, 24 h).
Time frame: Intraoperative and first 24 hours postoperative
Amount of Analgesic required in the first day after surgery
The total dose of intravenous (IV) acetaminophen 15 mg/kg if FLACC scores between 2 and 4 at the first 24 h after surgery, and total dose of tramadol 1 mg/kg (IV) in case of FLACC score \> 4.
Time frame: First 24 hours postoperative
Time to first rescue analgesic demand after surgery.
measured from the end of surgery till patient require analgesia.
Time frame: First 24 hours postoperative
Success rate of block
a successful block is defined as absence of significant changes in heart rate following surgical induction. Heart rate increase is not\>20% of the basal levels. If the increase is\>20%, the block is accepted as unsuccessful.
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Time frame: Intraoperative duration
Duration of performing the block
Block performing time is defined as the period between the insertion of the needle and termination of local anesthetic administration
Time frame: Intraoperative duration
Incidence of complications
Hypotension, bradycardia, postoperative nausea, vomiting, urinary retention, prolonged motor block, pruritus and local anesthetic systemic toxicity (LAST).
Time frame: Intraoperative and first 24 hours postoperative