Postoperative Analgesic Effect of Two Peripheral Nerve Blocks for Hip Surgery in Pediatrics
Condition: Pain, Postoperative; Developmental Dysplasia of the Hip; Regional Anesthesia Morbidity
MeSH terms: Developmental Dysplasia of the Hip; Hip Dislocation, Congenital; Pain, Postoperative
Study type: Interventional

Summary: 
      Hip joint surgery for developmental dysplasia of the hip (DDH) in children is extremely
      painful and associated with considerable postoperative pain despite the use of systemic
      opioids. Caudal anesthesia and lumbar plexus block (LPB) were still the most common regional
      anesthesia techniques for perioperative analgesia in children undergoing this type of
      surgery. recently, pediatric anesthesiologists don't consider choosing both techniques
      because of potential complications such as intravascular and intrathecal injection, and urine
      retention. novel peripheral nerve blocks have been advocated in pediatrics to avoid the
      aforementioned complications such as PEricapsular Nerve Group (PENG) block, Quadratus
      Lumborum Block (QLB), and Fascia Transversalis Plane Block (FTPB) The objective of the
      current study is to assess the analgesic efficacy of ultrasound-guided FTPB versus
      ultrasound-guided PENG block in pediatric patients undergoing open hip surgery for DDH
    

Detailed description: 
      During the pre-anesthesia check-up visit, the proposed intervention will be discussed with
      the eligible participant's parents or caregivers including data about the aim, the
      advantages, and the expected side effects, and then a detailed written informed consent will
      be obtained before recruitment and randomization.

      All participants will be premedicated with 0.5mg/kg oral midazolam about 30min before being
      admitted to the operating room. The routine standard monitoring including electrocardiography
      (ECG), non-invasive blood pressure (NIBP), pulse oximetry for blood oxygen saturation (SpO2),
      temperature probe, and end-tidal CO2 (EtCO2) will be applied to all participants. Induction
      of general anesthesia (GA) will be performed using a face mask with sevoflurane inhalation in
      oxygen starting with 2% up to 8% till complete loss of consciousness after that peripheral
      intravenous (IV) line will be secured where fentanyl 1 μg/kg and followed by cisatracurium
      0.15mg/kg to facilitate orotracheal intubation. Anesthesia will be maintained by using
      isoflurane 1.2-1.5% in oxygen air mixture 50%:50% in addition to incremental cisatracurium
      0.03mg/kg.

      After induction of GA, the eligible participants will be randomly assigned to one of two
      equal groups either FTPB or PENG block.

      In both interventional group participants, the assigned block will be performed after
      induction of GA by the same investigator who will have no further role in the study. Surgery
      will be started about 15 minutes after performing the block.

      Fentanyl 1μg/ kg will be administrated intraoperatively in the case of inadequate analgesia
      which is defined as an increase of heart rate (HR) and/or mean arterial blood pressure (MAP)
      more than 20% above the pre-operative values. At the end of the surgery, isoflurane will be
      switched off and extubation will be done after reversal of muscle relaxant with neostigmine
      0.05 mg/kg and atropine 0.02 mg/kg where the participants will be transferred to the
      Post-Anesthesia Care Unit (PACU). Paracetamol (15 mg/kg) will be administered IV every 6
      hours in all participants.
    

Intervention name(s): FTPB; PENG Block
Intervention type(s): Procedure; Procedure
Intervention description(s): A 22-gauge needle will be advanced from anterior using an in-plane technique and passed through the posterior 'tail' of the transversus muscle. the local anesthetic solution of 0.25% bupivacaine will be injected for a total volume of 0.5 ml/kg will be injected to separate the transversalis fascia from the transversus muscle.; A 22-gauge, 80-mm needle will be inserted from lateral to medial in an in-plane approach to place the tip in the musculofascial plane between the psoas tendon anteriorly and the pubic ramus posteriorly where the local anesthetic solution of 0.25% bupivacaine will be injected for a total volume of 0.5 ml/kg
Other intervention name(s): Fascia Transversalis Plane Block; Pericapsular Nerve Group block
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Prevention
Keywords: Fascia Transversalis plane block; pericapsular nerve group block; developmental dysplasia of the hip; postoperative analgesia; pediatric; hip surgery