Erector Spinae Plane Block Versus Quadratus Lumborum Block for Open Renal Surgeries in Children

Phase 4

• Conditions: Postoperative Pain, Acute
• Interventions: Procedure: Ultrasound-guided Erector Spinae Plane Block; Procedure: Ultrasound-guided Quadratus Lumborum Block; Device: Ultrasound Machine; Device: Echogenic needle; Drug: Fentanyl; Drug: Pethidine

• Registration Number: NCT05386121
• Lead Sponsor: Cairo University

Brief Summary

Open renal surgeries are associated with significant postoperative pain; early control of the perioperative pain is associated with decrease of hemodynamic variations during the surgery, early mobilization, better quality of functional recovery \& early discharge of patients. Side effects of systemic opioids, as well as difficulty to monitor their response, are major limitations to their use.

Pediatric regional anesthesia (PRA) is one of the most valuable and safe tools to treat perioperative pain, and is an essential part of modern anesthetic practice. Neuraxial analgesia for pediatric patients is a mode of pain control that gained popularity in the last few decades as it decreases opioid exposure, shortens recovery room time \& hospital stay. Caudal block is the most commonly used neuraxial anesthesia in pediatric patients. However, its major side effect is urinary retention and excessive motor block.

Considerable progress has been made in the practice of PRA over the past few years including incorporation of ultrasound guidance, with promising novel regional anesthesia techniques, especially the anterolateral and the posterolateral trunk blocks.

In this study, the investigators will compare the ultrasound guided quadratus lumborum block (QLB) with erector spinae plane block (ESPB), regarding the duration and quality of postoperative analgesia in pediatric patients undergoing unilateral open renal surgeries under general anesthesia. The study hypothesis is that QLB can provide a more superior postoperative pain relief to ESPB in children undergoing open renal surgeries.

Detailed Description

Not available

Study Timeline

• Status Verified: 2022-05
• Study First Submitted: 2022-05-08
• Study First Submitted QC: 2022-05-19
• Last Update Submitted: 2022-05-19
• Study Start: 2022-05-20
• Study First Posted: 2022-05-23
• Last Update Posted: 2022-05-23
• Primary Completion: 2022-09-01
• Study Completion: 2022-09-15

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: All
• Target Recruitment: 60

Inclusion Criteria

1. American society of anesthesiologists (ASA) class I and II
2. Children undergoing unilateral open renal surgeries

Exclusion Criteria

1. Parents refusal for the block
2. Bleeding disorders (platelets count < 100,000/uL; INR > 1.5; PC < 60%)
3. Skin lesion, wounds or infection at the puncture site.
4. Known allergy to local anesthetic drugs

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Erector spinae plane block (ESPB) group	Ultrasound-guided Erector Spinae Plane Block	30 child will receive a preoperative unilateral single shot US-guided erector spinae plane block at the level of T9 vertebra in the lateral position after induction of general anesthesia, using 0.5 mL/kg of bupivacaine 0.125%
Quadratus lumborum block (QLB) group	Ultrasound Machine	30 child will receive a preoperative unilateral single shot US-guided quadratus lumborum block at the level of L2 spinous process in the lateral position after induction of general anesthesia, using 0.5 mL/kg of bupivacaine 0.125%
Quadratus lumborum block (QLB) group	Echogenic needle	30 child will receive a preoperative unilateral single shot US-guided quadratus lumborum block at the level of L2 spinous process in the lateral position after induction of general anesthesia, using 0.5 mL/kg of bupivacaine 0.125%
Erector spinae plane block (ESPB) group	Fentanyl	30 child will receive a preoperative unilateral single shot US-guided erector spinae plane block at the level of T9 vertebra in the lateral position after induction of general anesthesia, using 0.5 mL/kg of bupivacaine 0.125%
Quadratus lumborum block (QLB) group	Ultrasound-guided Quadratus Lumborum Block	30 child will receive a preoperative unilateral single shot US-guided quadratus lumborum block at the level of L2 spinous process in the lateral position after induction of general anesthesia, using 0.5 mL/kg of bupivacaine 0.125%
Quadratus lumborum block (QLB) group	Pethidine	30 child will receive a preoperative unilateral single shot US-guided quadratus lumborum block at the level of L2 spinous process in the lateral position after induction of general anesthesia, using 0.5 mL/kg of bupivacaine 0.125%
Erector spinae plane block (ESPB) group	Ultrasound Machine	30 child will receive a preoperative unilateral single shot US-guided erector spinae plane block at the level of T9 vertebra in the lateral position after induction of general anesthesia, using 0.5 mL/kg of bupivacaine 0.125%
Erector spinae plane block (ESPB) group	Echogenic needle	30 child will receive a preoperative unilateral single shot US-guided erector spinae plane block at the level of T9 vertebra in the lateral position after induction of general anesthesia, using 0.5 mL/kg of bupivacaine 0.125%
Erector spinae plane block (ESPB) group	Pethidine	30 child will receive a preoperative unilateral single shot US-guided erector spinae plane block at the level of T9 vertebra in the lateral position after induction of general anesthesia, using 0.5 mL/kg of bupivacaine 0.125%
Quadratus lumborum block (QLB) group	Fentanyl	30 child will receive a preoperative unilateral single shot US-guided quadratus lumborum block at the level of L2 spinous process in the lateral position after induction of general anesthesia, using 0.5 mL/kg of bupivacaine 0.125%

Primary Outcome Measures

Name	Time	Method
Time to first postoperative rescue analgesia	12 hours	Time in minutes when postoperative Children's Hospital Eastern Ontario Pain Scale (CHEOPS) pain score exceeds 6 for the first time. Children's Hospital Eastern Ontario Pain Scale is a pain score with the least possible score is 4, while the highest possible score 13 (worse outcome).

Secondary Outcome Measures

Name	Time	Method
Intraoperative heart rate	During surgery (from induction of general anesthesia till 15 mins. after performance of the nerve block)	measured before and after induction of general anesthesia, after performance of the nerve block and at 1,5,10, 15 mins. after
Total opioid analgesic consumption in the first 12 hours postoperative period	from time of patient transfer to the PACU, till 12 hours postoperatively	when postoperative Children's Hospital Eastern Ontario Pain Scale (CHEOPS) pain score ˃ 6 in the first 12 hours postoperatively. Children's Hospital Eastern Ontario Pain Scale is a pain score with the least possible score is 4, while the highest possible score 13 (worse outcome).
Intraoperative mean arterial blood pressure	During surgery (from induction of general anesthesia till 15 mins. after performance of the nerve block)	measured from induction of general anesthesia, after performance of the nerve block and at 1,5,10, 15 mins. after
Postoperative pain score	from time of patient transfer to the PACU, till 12 hours postoperatively	measured at time of patient transfer to the PACU, 15, 30 mins, 1 ,2 , 4 ,6 ,12 hours after surgery
Block performance time	Time from ultrasound visualization of target injection site to end of local anesthetic (bupivacaine) deposition up to 15 mins.	Time to perform ultrasound guided nerve block