Ultrasound-Guided Combined Pericapsular Nerve Group Block and Lateral Femoral Cutaneous Nerve Block Versus Caudal Block for Postoperative Analgesia in Pediatric Hip Surgeries. A Randomized Controlled Study.
Overview
- Phase
- Phase 2
- Intervention
- Caudal epidural analgesia
- Conditions
- Pericapsular Nerve Group Block
- Sponsor
- Kasr El Aini Hospital
- Enrollment
- 68
- Locations
- 1
- Primary Endpoint
- Time to first rescue analgesia
- Status
- Recruiting
- Last Updated
- last year
Overview
Brief Summary
combined pericapsular nerve group PENG block and lateral femoral cutaneous nerve block may be effective in reducing post-operative pain after open hip surgery in children.
Detailed Description
All children will be assessed clinically, and investigations will be done to exclude the exclusion criteria mentioned above. Laboratory works needed: complete blood count (CBC), prothrombin time, concentration, partial thromboplastin time. Midazolam (0.5mg/kg) will be given orally to each child in both groups as a premedication half an hour before the procedure. General anesthesia will be induced in a supine position under standard basic monitoring of vital signs with inhalational anesthetic using (100%) O2 + Sevoflurane. Group C will receive caudal analgesia Bupivacaine 0.25% at a dose of 1 ml/kg. Group B will receive PENG block Bupivacaine 0.25% at a dose of 1 ml/kg and lateral femoral cutaneous nerve block Bubivacaine 0.25% at 0.1 ml/kg. After receiving the block, a surgical incision will be done after 15 minutes. Continuous recording of heart rate and blood pressure will be carried out from the moment of injection at timely intervals intra-operative. Intra-operatively, an increase in hemodynamics in response to the skin incision by more than 30% from baseline values 5 min after intubation or thereafter is managed by intravenous administration of fentanyl 1 µg/kg to a maximum dose of 2 µg/kg. Postoperative pain assessment using the FLACC score will then follow for 24 hours.
Investigators
maged gamal
Anesthesia lecturer
Kasr El Aini Hospital
Eligibility Criteria
Inclusion Criteria
- •American Society of Anesthesiologists (ASA) physical status I, II.
- •Unilateral hip surgery.
Exclusion Criteria
- •Parents' refusal to participate in the study.
- •Coagulopathy (i.e. Platelets ≤ 50,000 and/or INR\> 1.5).
- •Localized infection at the site of needle insertion.
- •Known hypersensitivity or allergies to any of the used drugs.
- •Bilateral hip surgery in the same session.
Arms & Interventions
Group C
Patients will receive caudal analgesia
Intervention: Caudal epidural analgesia
Group C
Patients will receive caudal analgesia
Intervention: Fentanyl
Group C
Patients will receive caudal analgesia
Intervention: Morphine
Group C
Patients will receive caudal analgesia
Intervention: Acetaminophen
Group B
patients will receive PENG block and Lateral Femoral Cutaneous Nerve block
Intervention: Ultrasound-guided Combined Pericapsular Nerve Group Block
Group B
patients will receive PENG block and Lateral Femoral Cutaneous Nerve block
Intervention: Ultrasound-guided Lateral Femoral Cutaneous Nerve Block
Group B
patients will receive PENG block and Lateral Femoral Cutaneous Nerve block
Intervention: Fentanyl
Group B
patients will receive PENG block and Lateral Femoral Cutaneous Nerve block
Intervention: Morphine
Group B
patients will receive PENG block and Lateral Femoral Cutaneous Nerve block
Intervention: Acetaminophen
Outcomes
Primary Outcomes
Time to first rescue analgesia
Time Frame: First 24 hours postoperative
Time (minutes) to first need of rescue analgesia postoperative.
Secondary Outcomes
- Intraoperative hemodynamic parameters(intraoperative period)
- Total fentanyl consumption(intraoperative period)
- Total morphine consumption(First 24 hours postoperative)
- Postoperative pain assessment FLACC(First 24 hours postoperative)