Erector Spinae Plane Block in Pediatric Lower Limb Surgery
Condition: Efficacy of Erector Spinae Plane Block in Lower Limb Surgery in Pediatric
Study type: Interventional

Summary: 
      Anesthesia will be induced in all patients using Fentanyl 1µg,propofol 2mg/kg and
      cisatracurium 0.15 mg/kg IV to facilitate endotracheal intubation, maintenance of anaesthesia
      afterward will be achieved by isoflurane1.5-2% in oxygen and air mixture, cisatracurium0.03
      mg/kg.

      In both groups , ultrasound guided block will be performed by an experienced anesthesiologist
      who has no subsequent role in the study after induction of anesthesia and before starting of
      surgery in lateral position, sterilized and covered with sterile sheets. Aseptic precautions
      is taken by wearing sterile gowns and gloves A sterile preparation of the ultrasound probe is
      obligatory. Outcome parameters will be assessed by another anesthesiologist blinded to the
      groups of assignment.

      Group 1: group of ultrasound guided Erector spine plane block:

      Group 11: group of ultrasound guided Cauda block:
    

Detailed description: 
      Ethical considerations:

        -  After approval from institutional ethics committee, an informed consent will be obtained
           from all parents of participants in this research. All data of patients will be
           confidential with secret codes and private file for each patient, and all given data
           will be used for the current medical research only.

        -  Any unexpected risks appear during the course of the research will be cleared to the
           participants and ethical committee on time and proper measures will be taken to overcome
           or minimize these risks Patients will be randomized into two equal groups at a ratio of
           1:1 to receive either Erector spine plane block (Group I n= 25) or Caudal block (Group
           II n= 25).

      Randomization will be performed using sealed opaque envelopes indicating the group of
      assignment. A blinded nurse, who will not participate in the study or data collection, read
      the number contained in the envelope and made group assignments.

      A preoperative evaluation in form of history taking, clinical examination and routine
      laboratory investigations, On arrival to the operating room, an intravenous (IV) cannula
      24-22 gauge will be inserted and standard monitoring in terms of electrocardiogram (ECG),
      non-invasive blood pressure, capnograph and pulse oximeter for oxygen saturation (SpO2) will
      be connected to each participants. Patient received ,05mg midazolam and 4 mg ondansetron.

      Anesthesia will be induced in all patients using Fentanyl 1µg,propofol 2mg/kg and
      cisatracurium 0.15 mg/kg IV to facilitate endotracheal intubation, maintenance of anaesthesia
      afterward will be achieved by isoflurane1.5-2% in oxygen and air mixture, cisatracurium0.03
      mg/kg.

      In both groups , ultrasound guided block will be performed by an experienced anesthesiologist
      who has no subsequent role in the study after induction of anesthesia and before starting of
      surgery in lateral position, sterilized and covered with sterile sheets. Aseptic precautions
      is taken by wearing sterile gowns and gloves A sterile preparation of the ultrasound probe is
      obligatory. Outcome parameters will be assessed by another anesthesiologist blinded to the
      groups of assignment.

      Group 1: Technique of ultrasound guided Erector spine plane block:

      The pa¬tient will be placed in in left lateral decubitus and the ultrasound-guided ESP block
      was performed at the(T12-L4) level on the left side.A 18_20 needle was inserted with the
      bevel in cephalo- caudal direction and 0.5 ml Kg of 0.25% Bupivacaine were injected Group 11:
      Technique of ultrasound guided Cauda block: With the patient in the left lateral decubitus
      position and the hips and knees flexed, the sacral hiatus can be identified using ultrasound
      First of all, the posterior superior iliac spines are palpated via anatomical landmarks, the
      line between both spines representing the base of an equilateral triangle the tip of which
      indicates the position of the sacral hiatus. The sacro coccygeal ligament can be palpated
      between the two sacral cornua, which is where the needle should penetrate the skin at an
      approximate 45 angle. Once the ligament has been passed, a flatter angle is adjusted by
      descending the needle before it can be advanced to the correct final position. Local
      anesthesia 0.5 ml Kg of 0.25% Bupivacaine were injected. Before application of local
      anesthetic , cautious aspiration or passive drainage is required to rule out an inadvertent
      intravascular or spinal needle location. Ultrasound guidance, by comparison ,offers two key
      advantages: it helps to identify small anatomical structures, and allows the spread of the
      local anesthetic to be seen by placing it longitudinally in a position slightly Para median
      to the lumbar spine .
    

Intervention name(s): erector spinae plane block; ultrasound guided caudal block
Intervention type(s): Procedure; Procedure
Intervention description(s): determine the efficacy and safety of ultra-sound guided erector spine plane block for providing postoperative analgesia in pediatric patients scheduled for lower limb surgeries as regard pain score , duration of analgesia and total postoperative analgesic requirement as a primary outcome as well as their safety as regard hemodynamics, adverse events local complications as secondary outcomes.; determine the efficacy and safety of ultra-sound guided caudal block for providing postoperative analgesia in pediatric patients scheduled for lower limb surgeries as regard pain score , duration of analgesia and total postoperative analgesic requirement as a primary outcome as well as their safety as regard hemodynamics, adverse events local complications as secondary outcomes.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Supportive Care
Keywords: erector spinae -block-pediatric -lower limb