Quadratus Lumborum Block for Pediatric Hip Surgery

Not Applicable

Completed

• Conditions: Hip Dislocation, Congenital; Postoperative Pain; Anesthesia

• Registration Number: NCT04292782
• Lead Sponsor: University Tunis El Manar

Brief Summary

Caudal blockade (CB) is one of the most frequently performed regional anaesthetic techniques in children. It's an efficient way to offer perioperative analgesia for painful sub-umbilical interventions but with high incidence of motor block and urinary retention. In one study, psoas compartment block was associated with less morphine comsumption and prolonged duration of analgesia compared to single-shot caudal Block in small children undergoing open hip reduction/osteotomies. Ultasound guided anterior Quadratus lumborum block (AQLB) provides unilateral analgesia to the nerves between the psoas muscle (PM) and the quadratus lumborum muscle (QLM). The first pediatric study evaluating Quadratus lumborum block is encouraging .

The first pediatric study evaluating Quadratus lumborum block is encouraging. To the best of the investigator's knowledge, there are no previously published data comparing the AQLB with other regional techniques in infants undergoing hip surgery.

Detailed Description

The aim of this prospective randomized study was to compare the analgesic effects between AQLB and CB in children undergoing unilateral open hip reduction/osteotomies for hip dislocation.

Patients were randomly assigned, into 1 of 2 groups, namely, group CB (n = 20) and group AQLB (n = 20).

Preoperatively all children were premedicated by using oral midazolam (0 .5mg/kg).

anesthesia was induced with 3 to 4% sevoflurane and 50% with 60% nitrous oxide in oxygen.Then fentanyl 3 μg/kg and Propofol 1 - 2mg/Kg were administered for anesthesia induction. Airway was secured with endotracheal tube placed in the mouth facilited by 0.15 mg/kg cistracurium. Anesthesia maintenance was performed with sevoflurane 2% in 50% nitrous oxide.

AQLB and CB were done with 1 ml/kg, 0.25% Ropivacaine (maximum dose limited to 20 ml)

Postoperative follow-up:

All patients received 15 mg/kg paracetamol before extubation. Tramadol 2 mg/kg intravenous was planned as rescue analgesia when CHEOPS score was more than 3. Supplemental IV tramado, 1 mg/kg could be added if necessary every 6 hours.

Study Timeline

• Study First Submitted: 2020-02-23
• Study First Submitted QC: 2020-03-01
• Study First Posted: 2020-03-03
• Study Start: 2020-03-31
• Primary Completion: 2021-03-30
• Study Completion: 2021-12-31
• Status Verified: 2024-02
• Last Update Submitted: 2024-02-11
• Last Update Posted: 2024-02-13

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 40

Inclusion Criteria

• Patients aged 2 to 7 years old
• Weight ≤ 20 Kg
• American Society of Anesthesiologists (ASA) physical status I or II
• Planned to undergo unilateral open hip reduction/osteotomies

Exclusion Criteria

• Cerebral palsy with severe intellectual disability
• Coagulation disorders
• Local or general infection
• Allergy to amide local anesthetics.
• Progressive neurological disorders
• Parenteral refusal
• Spinal dysraphism
• Cutaneous anomalies (angioma, hair truft, naevus or a dimple)near to the puncture

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Primary Outcome Measures

Name	Time	Method
analgesics consumption	day one	total tramadol consumption

Secondary Outcome Measures

Name	Time	Method
analgesic rescue	Day one	time to first analgesic rescue
postoperative pain score	day one	Children's Hospital Eastern Ontario Pain Scale (CHEOPS) \[4=no pain ; 13=worst pain\]

Trial Locations

Locations (1)

Institut Kassab D'Orthopedie; 🇹🇳 Tunis, Tunisia