Comparison of Ultrasound Guided Erector Spinae Plane Block and Ultrasound Guided Pericapsular Nerve Group Block for Pediatric Hip Surgery

Not Applicable

Completed

• Conditions: Postoperative Pain
• Interventions: Procedure: pericapsular nerve group block; Procedure: erector spinae plane block

• Registration Number: NCT04373577
• Lead Sponsor: Tanta University

Brief Summary

Surgical repair of the hip can be extremely painful and is associated with considerable postoperative pain in children despite the use of systemic opioids. These patients may benefit from neuraxial analgesia in adjunction with general anesthesia. The reported advantages of this technique include decreased opiate exposure, decreased time in the post-anesthesia recovery room, decreased hospital stay, reduce the post-operative morbidity, provide early mobilization. Regional anesthetic techniques seem to be a better choice for improving acute pain management in these patients, with fewer adverse effects.

Detailed Description

Surgical repair of the hip can be extremely painful and is associated with considerable postoperative pain in children despite the use of systemic opioids. These patients may benefit from neuraxial analgesia in adjunction with general anesthesia. The reported advantages of this technique include decreased opiate exposure, decreased time in the post-anesthesia recovery room, decreased hospital stay, reduce the post-operative morbidity, provide early mobilization.

Regional anesthetic techniques seem to be a better choice for improving acute pain management in these patients, with fewer adverse effects. The erector spinae block is a recently described ultrasound-guided technique in which local anesthetics is injected into a fascial plane between the tips of the thoracic transverse processes and the overlying erector spinae muscle (longissimus thoracis).

Pericapsular nerve group (PENG) block has been recently recommended by Girón-Arango et al. for use as postoperative analgesia in hip surgeries. It is a new regional anesthesia technique in the region between the anterior inferior iliac spine (AIIS) and ilio-pubic eminence (IPE).

The anterior capsule is the most richly innervated section of the joint suggesting these nerves should be the main targets for hip analgesia.

Study Timeline

• Study First Submitted: 2020-04-28
• Study Start: 2020-05-01
• Study First Submitted QC: 2020-05-01
• Study First Posted: 2020-05-04
• Primary Completion: 2022-09-01
• Study Completion: 2022-10-01
• Status Verified: 2022-11
• Last Update Submitted: 2022-11-23
• Last Update Posted: 2022-11-25

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 56

Inclusion Criteria

• Children of both genders
• American Society of Anaestheologists (ASA) physical activity I, II
• aged more than one year
• admitted for elective pediatric hip surgery

Exclusion Criteria

• Children with severe systemic disease with American Society of Anaestheologists (ASA) III or IV,
• children with previous neurological or spinal disorders,
• coagulation disorder,
• infection at the block injection site,
• history of allergy to local anesthetics
• bilateral hip surgery.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
PENG group	pericapsular nerve group block	Under ultrasound guidance, patients of this group will receive (0.5ml/kg) plain bupivacaine 0.25%with adrenaline 2.5 µg/ml injected as the tip of the needle in the musculofascial plane between the psoas tendon anteriorly and the pubic ramus posteriorly
ESP group	erector spinae plane block	Under ultrasound guidance, patients of this group will receive (0.5ml/kg) plain bupivacaine 0.25%with adrenaline 2.5 µg/ml injected beneath the erector spinae muscle sheath at the level of the transverse process of the second lumbar vertebrae

Primary Outcome Measures

Name	Time	Method
Time to first rescue analgesic demand	postoperative first day	Time to first rescue analgesic requirement: measured from the end of surgery till patient require analgesia.

Secondary Outcome Measures

Name	Time	Method
Total doses of intraoperative fentanyl consumption	intraoperative	Total doses of intraoperative fentanyl consumption
Total analgesic consumption	postoperative first day	Total analgesic consumption If pain score more than 3, the child will be given intravenous morphine as rescue analgesia will be given in a dose 0.1mg/kg.

Trial Locations

Locations (1)

Tarek Abdel Hay; 🇪🇬 Tanta, El Gharbyia, Egypt