Lateral Versus Posterior Quadratus Lumborum Block in The Pediatric Patients Undergoing Orchiopexy
Condition: Pain
Study type: Interventional

Summary: 
      There is a complex innervation of the testis and spermatic canal, and many different regional
      analgesia methods can be used for pain occurring during and after undescended testicular
      surgery. Quadratus lumborum block (QLB) can be count as the one of the primary method to
      manage the pain.

      In this study, our primary aim will be to compare the effects of lateral and posterior QLB
      application on perioperative and postoperative pain and analgesic use in pediatric patients
      who will undergo unilateral elective undescended testicular surgery. Our secondary aim will
      be to compare patient and family satisfaction and complications.
    

Detailed description: 
      American Society of Anesthesiologists Physical Status Classification System (ASA) class
      I-III, aged 6 month-12 years old children undergoing unilateral elective orchiopexy with
      general anesthesia will be recruited, after the informed consent will be obtained from the
      parents of the patients, in this triple blind randomized controlled trial.

      After the premedication with ketamine and midazolam will be performed, the patient will be
      brought to the operation room. After the induction with thiopental 5mg/kg, fentanyl 1mcg/kg,
      rocuronium 0.6mg/kg, patients will be intubated. The maintenance of the anesthesia will be
      provided with sevoflurane.

      Subsequently, before the surgery, the patients will be randomized and separated into 2
      groups. The investigators will apply the lateral QLB to the first group and posterior QLB to
      the other group. 0.4 ml/kg %0.25 bupivacaine will be used as a local anesthetic agent in both
      group.

      In the peroperative period, if the additional analgesia will necessary, remifentanyl
      0.1mcg/kg/min will be started, and dosage will be adjusted according to heart rate and blood
      pressure. If the blood pressure or heart rate will increase more than 20% from the
      preoperative basal value will be defined as the need for the analgesia.

      In the postoperative period, all cohort will be assessed by a blinded investigator at the
      10,20,30th minutes, 1,2nd hours in the recovery room, 6th hour in the surgical ward, Face,
      Legs, Activity, Cry, Consolability Scale (FLACC) will be used for the pain evaluation. 16th
      and 24th hours will be monitored by the telephone visit from the parents, the pain will be
      evaluated with the Wong-Baker Faces Pain Rating Scale due to the same-day surgery concept.
    

Intervention name(s): Lateral Quadratus Lumborum block; Posterior Quadratus Lumborum Block
Intervention type(s): Procedure; Procedure
Intervention description(s): Local anesthetic may spread to the T6-L1 spinal nerves and paravertebral area by spreading through the lateral QLB to the transversus abdominis plane, and posteriorly via the anterior thoracolumbar fascia.; In posterior QLB, the local anesthetic can spread on the anterior and lateral cutaneous branches of T4-L1 spinal nerves by administration of the agent to the lateral interfascial triangle.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Other
Keywords: quadratus lumborum block; pediatric patient; orchiopexy; pain; regional anesthesia