Quadratus Lumborum Block for Pediatric Hip Surgery

Postoperative Pain Clinical Trial

Official title:

Caudal Epidural Block Compared to Anterior Quadratus Lumborum Block for Pediatric Hip Surgery

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT04292782
• Other study ID #: CE-IMKO 104/2019
• Status: Completed
• Phase: N/A
• Start date: March 31, 2020
• Est. completion date: December 31, 2021

Study information

• Verified date: February 2024
• Source: University Tunis El Manar
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Caudal blockade (CB) is one of the most frequently performed regional anaesthetic techniques in children. It's an efficient way to offer perioperative analgesia for painful sub-umbilical interventions but with high incidence of motor block and urinary retention. In one study, psoas compartment block was associated with less morphine comsumption and prolonged duration of analgesia compared to single-shot caudal Block in small children undergoing open hip reduction/osteotomies. Ultasound guided anterior Quadratus lumborum block (AQLB) provides unilateral analgesia to the nerves between the psoas muscle (PM) and the quadratus lumborum muscle (QLM). The first pediatric study evaluating Quadratus lumborum block is encouraging .

The first pediatric study evaluating Quadratus lumborum block is encouraging. To the best of the investigator's knowledge, there are no previously published data comparing the AQLB with other regional techniques in infants undergoing hip surgery.

Description:

The aim of this prospective randomized study was to compare the analgesic effects between AQLB and CB in children undergoing unilateral open hip reduction/osteotomies for hip dislocation.

Patients were randomly assigned, into 1 of 2 groups, namely, group CB (n = 20) and group AQLB (n = 20).

Preoperatively all children were premedicated by using oral midazolam (0 .5mg/kg).

anesthesia was induced with 3 to 4% sevoflurane and 50% with 60% nitrous oxide in oxygen.Then fentanyl 3 μg/kg and Propofol 1 - 2mg/Kg were administered for anesthesia induction. Airway was secured with endotracheal tube placed in the mouth facilited by 0.15 mg/kg cistracurium. Anesthesia maintenance was performed with sevoflurane 2% in 50% nitrous oxide.

AQLB and CB were done with 1 ml/kg, 0.25% Ropivacaine (maximum dose limited to 20 ml)

Postoperative follow-up:

All patients received 15 mg/kg paracetamol before extubation. Tramadol 2 mg/kg intravenous was planned as rescue analgesia when CHEOPS score was more than 3. Supplemental IV tramado, 1 mg/kg could be added if necessary every 6 hours.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 40
• Est. completion date: December 31, 2021
• Est. primary completion date: March 30, 2021
• Accepts healthy volunteers: No
• Gender: All
• Age group: 2 Years to 7 Years

Eligibility

Inclusion Criteria:

• Patients aged 2 to 7 years old

• Weight = 20 Kg

• American Society of Anesthesiologists (ASA) physical status I or II

• Planned to undergo unilateral open hip reduction/osteotomies

Exclusion Criteria:

• Cerebral palsy with severe intellectual disability

• Coagulation disorders

• Local or general infection

• Allergy to amide local anesthetics.

• Progressive neurological disorders

• Parenteral refusal

• Spinal dysraphism

• Cutaneous anomalies (angioma, hair truft, naevus or a dimple)near to the puncture

Related Conditions & MeSH terms

• Anesthesia
• Developmental Dysplasia of the Hip
• Hip Dislocation
• Hip Dislocation, Congenital
• Postoperative Pain

Intervention

Procedure:
• anterior Quadratus lumborum block
ultrasound anterior quadratum lumborum block with 1 ml/kg 0.2% ropivacaine
• caudal block
ultrasound guided caudal block with 1 ml/kg 0.2% ropivacaine

Locations

Country	Name	City	State
Tunisia	Institut Kassab D'Orthopedie	Tunis

Sponsors (2)

Lead Sponsor	Collaborator
University Tunis El Manar	Institut Kassab d'Orthopédie

Country where clinical trial is conducted

Tunisia, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	analgesics consumption	total tramadol consumption	day one
Secondary	postoperative pain score	Children's Hospital Eastern Ontario Pain Scale (CHEOPS) [4=no pain ; 13=worst pain]	day one
Secondary	analgesic rescue	time to first analgesic rescue	Day one