ITM vs QL for Pediatric Open Lower Abdominal Procedures

Phase 4

Terminated

Conditions: Pain Control
Ureteral Reimplantation
Pediatrics
Intrathecal Morphine

Brief Summary: Patients between the ages of 12 months and 11 years who are undergoing an open lower abdominal procedure will be randomized to receive intrathecal morphine, or bilateral quadratus lumborum block. The investigators will compare the effect that intrathecal morphine and quadratus lumborum blocks have on the duration of pain control as demonstrated by charted pain scores and morphine equivalents in the first 48 hours. This study will also assess the side effects of each intervention such as nausea and vomiting, and itching.

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

Allergy to morphine or amide local anesthetics
Localized rash at site of planned regional anesthetic block
Bleeding diathesis
Spinal dysmorphism
Previous spinal surgery with instrumentation of the lumbar spine
Inability or unwillingness of parent or legal guardian to give informed consent.
Prior enrollment and randomization in this study

Arm && Interventions

Group	Intervention	Description
quadratus lumborum block	Quadratus lumborum block	Quadratus Lumborum Block: peripheral nerve block utilizing ropivacaine 0.2%, usually about ½ mL per kg per side (total dose approximately 1mL/kg).
Intrathecal Morphine	Intrathecal Morphine	Intrathecal Morphine: spinal (neuraxial) dose of preservative free morphine (duramorph), usually about 4-5mcg/kg

Primary Outcome Measures

Name	Time	Method
Duration of Analgesia - Pain Score 0-10	Up to 24 hours post-op	The primary endpoint will compare the effect that intrathecal morphine and quadratus lumborum blocks have on the duration of analgesia as demonstrated by charted pain scores in the first 24 hours. Pain scores were collected from the medical record on a scale from 0-10; the higher the score, the worse the outcome/pain. Time points in the 24 hours post op for each patient varied based on nursing care as the data was collected from the medical record.
Duration of Analgesia - MME/kg in First 24 Hours	Up to 24 hours post-op	The primary endpoint will compare the effect that intrathecal morphine and quadratus lumborum blocks have on the duration of analgesia as demonstrated by morphine milligram equivalents (MME)/kg in the first 24 hours. The higher the MME/kg, the worse the pain.

Secondary Outcome Measures

Name	Time	Method
Number of Participants With Side Effects of Each Intervention	up to 48 hours post-operative	The secondary endpoint will assess the side effects of each intervention such as nausea and vomiting, and pruritis.
Severity of Side Effects With Each Intervention	0-48 hours post-operatively	The secondary endpoint assesses the severity of side effects with each intervention such as nausea and/or vomiting, and pruritus in the patients who experienced a side effect. Parents of participants who experienced the side effects listed rated the severity of them using a Visual Analog Scale from 0-100mm. The higher the score, the worse the side effect.
Patient/Family Satisfaction	up to 48 hours post-operative	This endpoint will assess patient and family overall satisfaction with their child's pain control and experience of their child's post-op recovery. Satisfaction will be rated using VAS 0 (not satisfied) to 100 (completely satisfied).
Total Length of PACU Stay - Minutes	time to discharge after surgery, (an expected average length of hospital stay is approximately 2-4 days)	This endpoint will assess how long the patient's PACU stay was in minutes. The longer the stay, the worse the outcome.
Total Length of Hospital Stay - Length of Stay, Days	time to discharge after surgery, (an expected average length of hospital stay is approximately 2-4 days)	This endpoint will assess how long the patient's hospital stay was overall in days. The higher the number of days, the worse the outcome.