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Although scalp nerve blocks have been shown to provide effective postoperative analgesia in pediatric neurosurgical procedures, limited data exist on their use under ultrasound guidance. The smaller anatomical structures and higher vascularity of the pediatric scalp increase the risk of inadvertent vessel puncture or systemic toxicity with landmark-based techniques. Ultrasound guidance enables direct visualization of the targeted nerves and adjacent vessels, potentially improving block accuracy and safety. To date, no randomized controlled trial has compared ultrasound-guided versus conventional scalp block specifically in pediatric supratentorial tumor surgeries. This study aims to fill this gap.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Ultrasound-guided scalp block using bupivacaine | Active Comparator | patients will recieve ultrasound-guided scalp block using bupivacaine |
|
| conventional scalp block using bupivacaine | Active Comparator | patients will recieve conventional scalp block with bupivacaine using a landmark-based technique |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Ultrasound-guided scalp block | Procedure | Patients will receive ultrasound-guided scalp block using bupivacaine 0.25% at 0.1-0.2 mL/kg per nerve site, not exceeding a total dose of 2.5 mg/kg. |
| Measure | Description | Time Frame |
|---|---|---|
| Mean arterial blood pressure intraoperatively from baseline till skin incision | The mean arterial blood pressure recorded during 5 minutes immediately before skin incision till the peak mean arterial blood pressure recorded within the first minute after incision | from 5 minutes immediately before skin incision till the peak mean arterial blood pressure recorded within the first minute after incision |
| Measure | Description | Time Frame |
|---|---|---|
| Duration of analgesia | The time to the first postoperative analgesic request | 24 hours postoperatively |
| objective pain scale | objective pain scale is based on 5 criteria: (1) systolic arterial blood pressure, (2) crying, (3) movement, (4) agitation, and (5) verbal evaluation (complaint of pain). Each criterion is allocated a score of 0 to 2 (2 being the worst), giving a minimum OPS score of 0 and the maximum possible score of 10; the worst OPS score is 10 if the child is old enough to complain of pain and 8 if the child is too young to complain of pain |
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Inclusion Criteria:
Exclusion Criteria:
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| ID | Term |
|---|---|
| D010149 | Pain, Postoperative |
| ID | Term |
|---|---|
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010146 | Pain |
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| conventional scalp block | Procedure | Patients will receive conventional scalp block using landmark-based technique with bupivacaine 0.25% at 0.1-0.2 mL/kg per nerve site, not exceeding a total dose of 2.5 mg/kg. |
|
| 2, 4, 6, 8, 12, 16, and 24 hours postoperatively |
| Total doses of ketorolac | 24 hours postoperatively |
| 6. Total dose of paracetamol | 24 hours postoperatively |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |