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This study evaluates analgesic effects of ultrasound-guided (USG) regional anesthetic techniques; caudal block , transversus abdominis plane (TAP) block and quadratus lumborum block (QLB) by comparing postoperative pain scores [ Face, Legs, Activity, Cry, Consolabilty(FLACC) and Visual Analogue Scale (VAS)], first analgesic requirement time and total analgesic consumption in pediatrics undergoing lower abdominal surgery. We also aim to observe the side effects of these techniques such as nausea, vomiting, bradycardia, hypotension, respiratory depression.
Lower abdominal surgeries affect dermatomes T10-L1 and blocking these nerve roots provides effective postoperative analgesia. Neuroaxial blocks such as epidural and caudal blocks is considered the gold standart regional technique for pain management after lower abdominal surgery, blocking both somatic and visceral pain. Nowadays,US is increasingly used to perform caudal block, demostrating cannule placement and precise deposition of local anesthetic in the epidural space. On the other side truncal blocks as US-guided TAP block covers T10-L1 dermatomes and provides postoperative pain relief after lower abdominal surgery with lower complication rate rather than caudal block but it may not prevent traction on the peritoneal sac. QLB is rather a new regional technique blocking nerve roots close to paravertebral area affecting somatic and visceral nerve fibers. In our study we aim to compare postoperative analgesic effects of these three techniques in paediatrics. Our primary outcomes are pain scores(FLACC/VAS) and first additional analgesic requirement time. Secondary outcomes are total analgesic consumption, side effects (nausea, vomiting, itching, urinary retention, bradycardia, hypotension, respiratory depression), length of hospitalization and chronic pain due to incision after 2 months.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Quadratus Lumborum Block | Active Comparator | US-guided quadratus lumborum block will be performed with 0,5 ml/kg 0.25% Bupivacaine in the anterior layer of the thoracolumbar fascia between psoas major and quadratus lumborum muscles |
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| Transversus Abdominis Plane Block | Active Comparator | US- guided transversus abdominis plane block will be performed with 0,5 ml/kg 0.25% Bupivacaine into the fascial plane between internal oblique muscle and transversus abdominis muscle |
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| Caudal Block | Active Comparator | US-guided caudal epidural block will be applied to 0.7 ml/kg 0.25 % Bupivacaine up to a maximum of 20 mL |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Bupivacaine | Drug | % 0,25 |
|
| Measure | Description | Time Frame |
|---|---|---|
| Face, Legs Activity, Cry, Consolability (FLACC) scores | It includes five categories of behavior, each scored on 0-2 point scale so that total score ranges from 0 to 10. Total scores of 0-3 is defined as mild or no pain, 4-7 as moderate, and 8-10 as severe pain. | up to 48 hours |
| Measure | Description | Time Frame |
|---|---|---|
| Hospital stay | Hospitalisation | Through study completion, an average of 1 week |
| Number of patients who require rescue analgesic | Number of patients who require IV tramadol (1 mg/kg) at the first 2 hours and parasetamol in the 48 hours |
| Measure | Description | Time Frame |
|---|---|---|
| Incidence of side effects | Nausea, vomiting | up to 48 hours |
| Incidence of complications | Hematoma, dural puncture, infections | up to first week |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Meltem Savran Karadeniz | Istanbul University Faculty of Medicine Department of Anesthesiology | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Istanbul University | Istanbul | 34 | Turkey (Türkiye) |
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| Label | URL |
|---|---|
| Rectus sheath and transversus abdominis plane blocks in children: a systematic review and meta-analysis of randomized trials. | View source |
| Comparison of caudal epidural block and ultrasonography-guided transversus abdominis plane block for pain relief in children undergoing lower abdominal surgery. | View source |
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| ID | Term |
|---|---|
| D002045 | Bupivacaine |
| ID | Term |
|---|---|
| D000813 | Anilides |
| D000577 | Amides |
| D009930 | Organic Chemicals |
| D000814 | Aniline Compounds |
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RANDOMISED DOUBLE BLINDED INTERVENTIONAL
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| up to 48 hours |
| First analgesic requirement time | Duration of postoperative analgesia | Up to 48 hours |
| Time to first mobilization | Time to first mobilization | up to 48 hours |
| Quadratus Lumborum Block Versus Transversus Abdominis Plane Block in Children Undergoing Low Abdominal Surgery: A Randomized Controlled Trial. | View source |
| Ultrasound-Guided Transversus Abdominis Plane and Quadratus Lumborum Blocks | View source |
| D000588 |
| Amines |