Pediatric Postoperative Analgesia With Quadratus Lumborum Block(QLB) And Dexamethasone As An Adjuvant To Bupivacaine.
Condition: Post Operative Pain; Quadratus Lumborum Block; Pediatric; Abdominal Surgery
MeSH terms: Pain, Postoperative
Study type: Interventional

Summary: 
      Studying the post-operative analgesic effect of dexamethasone as an adjuvant to bupivacaine
      giving intravenously and locally with ultrasound guided quadratus lumborum block(QLB) in
      pediatrics undergoing abdominal surgeries
    

Detailed description: 
      After obtaining written informed consent from parents or guardians of all patients, 90
      patients (6-12 years old) scheduled for abdominal surgeries operations will be included.
      Patients will be randomly allocated into three groups, 30 patients in each group.
      Randomization will be based on computer-generated codes maintained in sequentially numbered
      opaque envelopes.

      Anesthetic Technique:

      Anesthesia will be induced with Sevoflurane plus fentanyl (0.5µg/kg) and tracheal intubation
      will be facilitated with Rocuronium (0.4 mg/kg). Anesthesia will be maintained with
      Sevoflurane (will be adjusted according to A line autoregressive index (AAI)) and Rocuronium
      (0.1 mg/kg/dose will be given on the basis of train-of-four neuromuscular monitoring). ECG,
      noninvasive blood pressure, heart rate, temperature, oxygen saturation, and exhaled CO2 (end
      tidal CO2) will be continuously monitored during the procedure.

      • After induction of anesthesia and before skin incision, a QLB will be performed in all
      patients in the three groups.

      The procedure will be done under ultrasound guidance using curved array transducer 5-2MHz
      (Sonosite ultrasound system). Echogenic needle, Sono Plex Stim cannula (PAJUNK) 22 gauge and
      60 mm length will be used. With the patient in the supine position, the site of the
      ultrasound and needle entry will be sterilized. The QLB block will be performed by anterior
      approach. The linear probe will be attached in the area of the triangle of Petit in
      transverse orientation in lateral abdomen in between the iliac crest and the costal margin,
      near the posterior axillary line. The muscle planes will be identified until visualizing the
      quadratus lumborum muscle, at the same plane as the psoas major muscle and the erector
      spinae. The needle tip is placed at the anterolateral border of the QL at its junction of QL
      with transversalis fascia outside the anterior layer of the thoracolumbar fascia (TLF) and
      fascia transversalis, and the local anesthetic will be injected.

      Anesthesia will be discontinued when the wound dressing applied, and muscle relaxant will be
      reversed using (50ug/kg) of neostigmine and atropine (0.02mg/kg) and extubating of the
      patient will be done. The patient will be transferred to the postoperative care unit (POCU).
    

Intervention name(s): ultrasound guided quadratus lumborum block; Dexamethasone Phosphate 4 MG/ML Injectable Solution intravenously; Bupivacaine Injection; Dexamethasone Phosphate 4 MG/ML Injectable Solution locally
Intervention type(s): Procedure; Drug; Drug; Drug
Intervention description(s): Ultrasound guided quadratus lumborum block will be done to all groups using curved array transducer 5_2 MHz with the patient in supine position and the block will be done by anterior approach; Using dexamethasone as an adjuvant to bupivacaine in ultrasound guided quadratus lumborum block which will be given intravenously in group A; Bupivacaine will be given to all groups locally with QLB; Using dexamethasone as an adjuvant to bupivacaine in ultrasound guided quadratus lumborum block which will be given locally in Group B
Other intervention name(s): Dexamethasone as an adjuvant intravenously; Light marcaine; Dexamethasone as an adjuvant locally
Intervention MeSH terms: Dexamethasone; Dexamethasone acetate; Bupivacaine; Pharmaceutical Solutions; Dexamethasone 21-phosphate; BB 1101
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: Quadratus lumborum block in pediatrics; Dexamethasone