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This study will be conducted to compare the efficacy and safety of ultrasound guided erector spinae block , ultrasound guided caudal block and conventional caudal block for pain management after pediatric hip surgery.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Conventional caudal block | Active Comparator | Patients of this group will receive the conventional method (blind technique without ultrasound) of caudal block |
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| Ultrasound-guided caudal block | Experimental | Patients of this group will receive caudal block using ultrasound. |
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| Ultrasound guided erector spinae plane Block | Experimental | Patients of this group will receive ultrasound guided erector spinae plane Block at the level of the transverse process of the second lumbar vertebrae(L2) . |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Conventional caudal block | Procedure | Patients of this group will receive (0.5ml/kg) (plain bupivacaine 0.25% injected in the caudal epidural space) by the conventional method (blind technique without ultrasound). |
| Measure | Description | Time Frame |
|---|---|---|
| Degree of pain intensity | To evaluate the pain scores by (FLACC) scale. (FLACC) scale will be assessed after surgery over 24 hours where (0 = Relaxed and comfortable, 1-3 = Mild discomfort, 4-6 = Moderate pain ,7-10 = Severe discomfort /pain) | First 24 hours postoperative |
| Measure | Description | Time Frame |
|---|---|---|
| Changes in mean arterial blood pressure | Mean arterial blood pressure will be recorded before block performance at T0, intraoperatively at 15 and 30 minutes, then every 30 min till the end of surgery and after surgery at T (0, 2, 4, 6, 12, 24 h). | Intraoperative and first 24 hours postoperative |
| Changes in heart rate |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Eman Hamdy Abu-Shanab, MSc | Contact | +201005518097 | eman.hamdy@med.tanta.edu.eg |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Tanta University Hospitals | Recruiting | Tanta | ElGharbiaa | 31527 | Egypt |
Data will be available upon reasonable request
For 1 year after the end of the study
The principal investigator will review requests
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| Ultrasound-guided caudal block | Procedure | Using ultrasound, patients of this group will receive (0.5ml/kg) (plain bupivacaine 0.25% injected in the caudal epidural space). |
|
| Ultrasound guided erector spinae plane Block | Procedure | Under ultrasound guidance, patients of this group will receive (0.5ml/kg) (plain bupivacaine 0.25% injected beneath the erector spinae muscle sheath) at the level of the transverse process of the second lumbar vertebrae(L2). |
|
Heart rate will be recorded before block performance at T0, intraoperatively at 15 and 30 minutes, then every 30 min till the end of surgery and after surgery at T (0, 2, 4, 6, 12, 24 h). |
| Intraoperative and first 24 hours postoperative |
| Amount of Analgesic required in the first day after surgery | The total dose of intravenous (IV) acetaminophen 15 mg/kg if FLACC scores between 2 and 4 at the first 24 h after surgery, and total dose of tramadol 1 mg/kg (IV) in case of FLACC score > 4. | First 24 hours postoperative |
| Time to first rescue analgesic demand after surgery. | measured from the end of surgery till patient require analgesia. | First 24 hours postoperative |
| Success rate of block | a successful block is defined as absence of significant changes in heart rate following surgical induction. Heart rate increase is not>20% of the basal levels. If the increase is>20%, the block is accepted as unsuccessful. | Intraoperative duration |
| Duration of performing the block | Block performing time is defined as the period between the insertion of the needle and termination of local anesthetic administration | Intraoperative duration |
| Incidence of complications | Hypotension, bradycardia, postoperative nausea, vomiting, urinary retention, prolonged motor block, pruritus and local anesthetic systemic toxicity (LAST). | Intraoperative and first 24 hours postoperative |