Ultrasound Guided Sacral Erector Spinae Plane Block in Pediatric Anorectal Surgery
Condition: Analgesia
Study type: Interventional

Summary: 
      This study will be conducted to evaluate efficacy of ultrasound guided sacral erector spinae
      plane block for postoperative analgesia in pediatric anorectal surgery in comparison to
      caudal block.
    

Detailed description: 
      Regional anesthesia in children has become increasingly popular over the past few decades. A
      variety of peripheral and central nerve blocks have been developed to ensure that
      perioperative pain can be effectively controlled. So, it possible to reduce the dose
      concentrations of systemic drugs and improved hemodynamic stability in high-risk patients.
      Erector spinae plane (ESP) block with various approaches been used in many surgeries and
      obtained great popularity despite of its novelty. After first description; lower thoracic,
      lumbar and sacral approaches were defined for postoperative analgesia. There are a few cases
      in which sacral ESP block was administered and reported.

      The aim of this study is to compare postoperative analgesic effect of ultrasound guided
      sacral ESP block and caudal block. It is hypothesized that sacral ESP block will be
      comparable to caudal block as a promising effective alternative for analgesia in patients who
      will undergo pediatric anorectal surgery with fewer side effects.

      This prospective, randomized, comparative clinical study will include 60 children who will be
      scheduled for elective anorectal surgery under general anesthesia in Mansoura university
      hospitals. Informed written consent will be obtained from parents of all subjects in the
      study after ensuring confidentiality. The study protocol will be explained to parents of all
      patients in the study who will be kept fasting prior to surgery. Patients will be randomly
      assigned to two equal groups (ESP and caudal) according to computer-generated table of random
      numbers using the permuted block randomization method. The collected data will be coded,
      processed, and analyzed using SPSS program. All data will be considered statistically
      significant if P value is ≤ 0.05.
    

Intervention name(s): Sacral ESP block; Caudal block; Bupivacaine Hydrochloride
Intervention type(s): Procedure; Procedure; Drug
Intervention description(s): A high-frequency ultrasound linear probe covered with a sterile sheath will be placed longitudinally to the midline of the sacrum. The median sacral crests and erector spinae muscle will be visualized, then a 22-gauge, 50 mm needle will be advanced from cranial to caudal direction until its tip touch the sacral crest.; A high-frequency ultrasound linear probe covered with a sterile sheath will be placed on to the sacrococcygeal region. The dura mater, epidural space, conus medullaris, sacral cornua, and sacrococcygeal ligament will be identified. Using the in-plane technique, a 22-gauge, 50 mm needle will be introduced to reach the sacral epidural space.; Following negative aspiration, a precalculated dose (0.5 ml/kg) of 0.25% bupivacaine will be injected.
Other intervention name(s): Ultrasound guided approach; Ultrasound guided approach; Marcaine
Intervention MeSH terms: Bupivacaine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Erector spinae plane block; Ultrasound guided; Sacral; Anorectal surgery