Transversus Abdominis Plane Versus Quadratus Lumborum Block for Pediatrics
Condition: Postoperative Pain
MeSH terms: Pain, Postoperative
Study type: Interventional

Summary: 
      The purpose of this research study is to find the best way to decrease pain in children whom
      have had low abdominal surgery. Investigators will perform two technique of trunk block;
      Transversus abdominis plane or Quadratus lumborum block .The method used is often chosen by
      which one the doctor has more experience using. The Investigator plans to find out if one of
      the methods is more effective and/or safer than the other method.

      The results of this study will help learn how to best control pain in children having surgery
      low abdominal surgery.
    

Detailed description: 
      Children aged 1-7 years undergoing lower abdominal surgeries would be recruited in this
      randomized study.

      Children would be monitored by electrocardiogram, pulse oximeter and non-invasive blood
      pressure.

      After preoxygenation for three minutes, anesthesia would be induced with 8% sevoflurane
      inhalation in 50% oxygen and % 50 air ; 1ug/kg fentanyl and 3 mg/kg propofol is administered
      intravenously. Then laryngeal mask is inserted when conditions are satisfactory (jaw relaxed,
      lash reflex disappeared, no coughing, gagging, swallowing).After ethical committee approval,
      informed written consent will be obtained from all patients.

      Consenting patients scheduled to have unilaterally low abdominal surgery(inguinal
      hernia,hydrocele,undescended testicles surgery will be randomised to unilateral Quadratus
      lumborum block or Transversus abdominis plane block at the begin of surgery.

      All patients will be in the lateral position . Under ultrasound guidance a 22 Gauge, Pajunk
      Sonoplex(medical Germany) needle will be used for both techniques. The spread of injectate
      will be seed on ultrasound.The dose of local anaesthetic in both groups will be 0.5 ml/kg 0.2
      % Bupivacaine. Anesthesia would be maintained with 2% sevoflurane An increase in blood
      pressure or heart rate by more than 15% from preoperative value was defined as insufficient
      analgesia and was treated with fentanyl 0.5 µ/kg. Saline dextrose 5% (1:1) solution was
      infused in a dose of 12 ml/ kg /h.

      All patients heart rate,MAP and Oxygen saturation record intraoperatively. All patients will
      receive paracetamol if requirement for postoperative analgesia.All patient will transfer from
      PACU to day-surgery unit (DSU) if they achieved Modified Aldrete Score of ten.

      All patients will be assessed postoperatively by a blinded investigator: in the
      postanesthesia care unit and at 30 min 1,2, 4, 6, 12, 24, hour postoperatively.FLACC score
      will be used.
    

Intervention name(s): Quadratus Lumborum Block; Transversus Abdominis Plane Block
Intervention type(s): Procedure; Procedure
Intervention description(s): After preoxygenation for three minutes, anesthesia would be induced with 8% sevoflurane inhalation in 50% oxygen and % 50 air ; 1ug/kg fentanyl and 3 mg/kg propofol is administered intravenously. Then laryngeal mask is inserted when conditions are satisfactory.All patients will be in the lateral position . Under ultrasound guidance a 22 Gauge, Pajunk Sonoplex(medical Germany) needle will be used for both techniques. Under ultrasound 0.5 ml/kg bupivacaine 0.2 % injected unilaterally at the posterior border of the quadratus lumborum muscle; After preoxygenation for three minutes, anesthesia would be induced with 8% sevoflurane inhalation in 50% oxygen and % 50 air ; 1ug/kg fentanyl and 3 mg/kg propofol is administered intravenously. Then laryngeal mask is inserted when conditions are satisfactory. All patients will be in the lateral position . Under ultrasound guidance a 22 Gauge, Pajunk Sonoplex(medical Germany) needle will be used for both techniques. Under ultrasound 0.5 ml/kg bupivacaine 0.2 % injected unilaterally between internal oblique and transversus abdominis muscles.
Other intervention name(s): QLB; TAP
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Other