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The aim of the study is to compare postoperative analgesia in pediatric patients undergoing inguinal hernia repair by comparing the efficacy of ultrasound guided paravertebral block versus ultrasound guided erector spinae plane block.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group paravertebral (PVB) block | Active Comparator | In the lateral decubitus and after sterilization and identifying the level of T10 ,linear ultrasound probe will be placed in the midline over the spinous process at the chosen level, then the probe will be moved laterally to view the lamina and hyperechoic transverse process ,the pleural should be visible as a bright white line .The needle should be inserted in -plane from lateral to medial and the needle tip should end in a hypoechoic triangular space .Correct needle placement should be confirmed by anterior displacement of pleura with injection of small volume of saline then 0.5 ml/kg of a mixture of 0.25 â„… bupivacaine and 1â„… lidocaine (1:1) will be injected |
|
| Group erector spinae plane (ESP) block | Active Comparator | In the lateral decubitus position ,after sterilization, the linear ultrasound probe will be placed over transverse process of T10 ,after optimizing the image in sagittal or transverse scanning ,A 50 mm 22-G needle will be placed under the erector spinae muscle in -in plane orientation until it contacted T8 transverse process in the cranial caudal direction ,after hydro dissection and confirmation that the tip of the needle is between the transverse process and the fascia of the erector spinae muscle group, 0.5 ml/kg of a mixture of 0.25 â„…bupivacaine and 1â„… lidocaine (1:1) will be injected and the surgery will be started after 15 min |
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| Control group (group C) | Active Comparator | will receive standard general anesthesia with pain management protocol without regional block. Pain management protocol for all patients will include IV paracetamol 15 mg/kg every 6 hrs. (max dose for children <50 kg is 60 mg/kg daily and if body weight ≥ 50 kg max dose is 4 gm daily) . Ibuprofen will be given as rescue analgesia 10 mg/kg IV if MOPS was > 3 at rest or after movement and can be repeated every 6 hrs not exceeding 400 mg/dose and max daily dose 40 mg/kg. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| ultrasound guided paravertebral block | Procedure | after sterilization and identifying the level of T10 ,linear ultrasound probe will be placed in the midline over the spinous process at the chosen level, then the probe will be moved laterally to view the lamina and hyperechoic transverse process ,the pleural should be visible as a bright white line .The needle should be inserted in -plane from lateral to medial and the needle tip should end in a hypoechoic triangular space. Correct needle placement should be confirmed by anterior displacement of pleura with injection of small volume of saline then 0.5 ml/kg of a mixture of 0.25 â„… bupivacaine and 1â„… lidocaine (1:1) will be injected |
| Measure | Description | Time Frame |
|---|---|---|
| The total amount of rescue analgesia (Ibuprofen consumption) | The total consumption of rescue analgesia (Ibuprofen consumption) postoperative | for 24 hours postoperative |
| Measure | Description | Time Frame |
|---|---|---|
| Pain intensity at rest (static) and after movement or coughing (dynamic) | by using 10 points Modified Objective Pain Score (MOPS)(0=no pain, 1-3=mild pain, 4-6=moderate pain, and 7-10= sever pain) | 0 minutes immediate postoperative ( on arrival to PACU), 30 minutes, 1hs, 2hs, 4hs, 8hs, 12 hrs and 24hs postoperatively |
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Inclusion Criteria:
1 - Parents acceptance
2. Age: preschool and school age child (24 months-12 years old).
3. Sex: both sex (males or females).
4. Physical status: ASA 1& II.
5. Type of operation: elective unilateral inguinal hernia repair
Exclusion Criteria:
1- Patient with any contraindications of regional blocks (as coagulopathy or local infection at injection site)
2. Patients with known history of allergy to the study drugs (bupivacaine and lidocaine).
3. Advanced hepatic, renal, cardiovascular, neurologic and respiratory diseases.
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Dina Sadek Salem, MD | Contact | 0109933513 | 002 | dinamaghraby@yahoo.com |
| Fatima Ahmed, MD | Contact | 01018951337 | 002 |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| faculty of human medicine, Zagazig university hospitals | Recruiting | El Sharkia | Egypt |
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Postoperative analgesia after inguinal hernia repair in pediatric by ultrasound guided paravertebral block or erector spinae block
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anesthetist not sharing in the study will assess patients
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| Ultrasound guided erector spinae plane block | Procedure | After sterilization, the linear ultrasound probe will be placed over transverse process of T10 ,after optimizing the image in sagittal or transverse scanning ,A 50 mm 22-G needle will be placed under the erector spinae muscle in -in plane orientation until it contacted T8 transverse process in the cranial caudal direction ,after hydro dissection and confirmation that the tip of the needle is between the transverse process and the fascia of the erector spinae muscle group, 0.5 ml/kg of a mixture of 0.25 â„…bupivacaine and 1â„… lidocaine (1:1) will be injected |
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| control group C | Procedure | will receive standard general anesthesia with pain management protocol without regional block. |
|
| The time to first request of rescue analgesia (Ibuprofen) |
the time from giving block till time of first request of ibuprofen when MOPS > 3 at rest or after movement |
| for 24 hours postoperative |
| The total number of patients requiring additional dose of intraoperative fentanyl. | Number of patients receive additional dose of intra operative fentanyl ( increase in the mean blood pressure or heart rate 20% above base line readings, fentanyl in a dose 0.5 mcg/kg will be given to the patient) | during operation period |
| To record the incidence of complications | To record the incidence of complications (hematoma, local anesthetic toxicity, pneumothorax, infection, hypotension, epidural or intrathecal spread) | 24 hours postoperative |
| Over all parent's satisfaction | The parents will be asked to rate the overall degree of satisfaction of the analgesia by using a 5-points likert-like verbal scale (1 = very dissatisfied analgesia, 2 = dissatisfied analgesia, and 3 = neutral, 4=satisfied analgesia, and 5=very satisfied analgesia) | 24 hours postoperative |
| Faculty of Human Medicine, Zagazig University | Recruiting | El Sharkia | Egypt |
|
| ID | Term |
|---|---|
| D000377 | Agnosia |
| ID | Term |
|---|---|
| D010468 | Perceptual Disorders |
| D019954 | Neurobehavioral Manifestations |
| D009461 | Neurologic Manifestations |
| D009422 | Nervous System Diseases |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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