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
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
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
DOUBLE
Enrollment
110
the efficacy of prepuncture ultrasonography to facilitate epidural block in pediatric patients undergoing elective urological operations compared with the conventional anatomical landmark technique
Mansoura University-Emergency hospital-ICU
Al Mansurah, Egypt
the rate of a successful reaching to the epidural space from the first needle pass
incidence after insertion of the epidural needle into the skin till reaching the epidural space
Time frame: minutes
the rate of a successful reaching to the epidural space from the first skin puncture
incidence after insertion of the epidural needle into the skin till reaching the epidural space
Time frame: minutes
The number of performed skin punctures by the epidural needle
number after insertion of the epidural needle into the skin till reaching the epidural space
Time frame: minutes
The number of needle passes from the same skin puncture required for reaching the epidural space
number from the skin puncture done by the epidural needle till removing the epidural needle from this the skin puncture
Time frame: minutes
The epidural space demarcation time by the ultrasound
The time from placing the ultrasound probe on the skin until the skin marking is completed at L3-4 and L2-3 space
Time frame: minutes
The epidural space demarcation time by the landmark
The time from start skin palpation til the skin marking is completed at L3-4 and L2-3 space
Time frame: minutes
The procedure time which is the time from the needle insertion into the skin until reaching the epidural space
Time frame: minutes
Incidence of intraoperative hypertension (as increase in systolic blood pressure (SBP) by more than 20% from the basal)
mmHg
Time frame: allover the surgery (minutes)
Incidence of intraoperative tachycardia (as increase in heart rate by more than 20% from the basal)
beat per minutes
Time frame: allover the surgery (minutes)
The procedure time
from the needle insertion into the skin till entering the epidural space
Time frame: minutes
pain score using "face, leg, activity, cry, consolability" (FLACC) scale
five criteria, which are each assigned a score of 0, 1 or 2
Time frame: 30 minutes after the patient has transferred to the recovery room
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