Analgesic Effect of Ultrasound Guided Errector Spinae Plane Block Versus Ultrasound Guided Caudal Block in Pediatric Open Renal Surgeries.
Condition: Analgesia , Open Renal Surgeries
Study type: Interventional

Summary: 
      comparison between the erector spinae block and caudal block with the aid of the of ultra
      sound in children as regard time of request of rescue analgesia , degree of intra and post
      operative pain relief , effect of hemodynamic stability and incidences of complication in
      open renal surgeries .
    

Detailed description: 
      Open Renal surgeries (pyeloplasty and nephrectomy) is associated with significant
      postoperative pain. Adequate postoperative analgesia is important to allow for early
      mobilization and discharge of the patients .Systemic opioids are usually not sufficient for
      pain control after renal surgeries in children. The use of opioid in pediatrics has many side
      effects such as somnolence, vomiting, and up to respiratory depression.

      Neuraxial analgesia is usually required in these operations in combination with general
      anesthesia. Neuraxial analgesia decreases morbidity, mortality, opiate exposure, shortens
      post anesthesia recovery room time and hospital stay. However, it is usually associated with
      many complications as urinary retention and excessive motor block.

      Caudal block is the most commonly used neuraxial anesthesia in pediatric patients. It can be
      used for analgesia in different renal surgeries providing adequate pain relief in the post-
      operative period .

      Paediatric regional anaesthesia (PRA) is one of the most valuable and safe tools to treat
      perioperative pain and is an essential part of modern anaesthetic practice. It offers many
      advantages to both the patient and the hospital. It provides excellent pain relief and allows
      caregivers to use multimodal analgesic techniques and decrease the use of opioids without the
      complications of neuraxial anesthesia. Considerable progress has been made in the practice of
      PRA over the past few years including availability of information on safety and incorporation
      of ultrasound guidance. Novel regional anaesthesia (RA) techniques, especially the
      anterolateral and the posterolateral trunk blocks, show promise .

      The erector spinae plane block (ESPB), one of the posterolateral trunk blocks, was first
      described by Forero et al. in 2016 and has been used by many anaesthesiologists for
      perioperative pain relief 4. Its mechanism of action is spreading of local anesthetic into
      multiple paravertebral spaces after injection into the interfascial space between the
      transverse process of the vertebrae and the erector spinae muscle. It can be used for
      postoperative analgesia for longer period and decrease the use of opioids with less
      complications in several pediatric surgeries including nephrectomy and pyeloplasty.

      For this reason, ESPB efficacy will be compared to the caudal block efficacy seeking for a
      simple, safe and effective regional analgesic technique for renal surgeries in children.

      Electrical Cardiometry is a method for the non-invasive determination of stroke volume (SV),
      cardiac output (CO), stroke volume variation (SVV) and other hemodynamic parameters in
      adults, children, and neonates and it has been validated against "gold standard" methods such
      as thermodilution. Several potential mechanisms have been suggested for the action of the
      ESPB such as paravertebral spread as well as epidural spread of local anesthetic. These
      mechanisms raise the concern of the possible negative hemodynamic consequences of the ESPB
      which were not properly investigated .
    

Intervention name(s): ultrasound guided blocks
Intervention type(s): Other
Intervention description(s): Ultrasound Guided Erector Spinae Plane Block Versus Ultrasound Guided Caudal Block in Pediatric
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: erector spinae block , caudal block