Comparison of Ultrasound Guided Erector Spinae Plane Block and Ultrasound Guided Pericapsular Nerve Group Block for Pediatric Hip Surgery
Condition: Postoperative Pain
MeSH terms: Pain, Postoperative
Study type: Interventional

Summary: 
      Surgical repair of the hip can be extremely painful and is associated with considerable
      postoperative pain in children despite the use of systemic opioids. These patients may
      benefit from neuraxial analgesia in adjunction with general anesthesia. The reported
      advantages of this technique include decreased opiate exposure, decreased time in the
      post-anesthesia recovery room, decreased hospital stay, reduce the post-operative morbidity,
      provide early mobilization. Regional anesthetic techniques seem to be a better choice for
      improving acute pain management in these patients, with fewer adverse effects.
    

Detailed description: 
      Surgical repair of the hip can be extremely painful and is associated with considerable
      postoperative pain in children despite the use of systemic opioids. These patients may
      benefit from neuraxial analgesia in adjunction with general anesthesia. The reported
      advantages of this technique include decreased opiate exposure, decreased time in the
      post-anesthesia recovery room, decreased hospital stay, reduce the post-operative morbidity,
      provide early mobilization.

      Regional anesthetic techniques seem to be a better choice for improving acute pain management
      in these patients, with fewer adverse effects. The erector spinae block is a recently
      described ultrasound-guided technique in which local anesthetics is injected into a fascial
      plane between the tips of the thoracic transverse processes and the overlying erector spinae
      muscle (longissimus thoracis).

      Pericapsular nerve group (PENG) block has been recently recommended by Girón-Arango et al.
      for use as postoperative analgesia in hip surgeries. It is a new regional anesthesia
      technique in the region between the anterior inferior iliac spine (AIIS) and ilio-pubic
      eminence (IPE).

      The anterior capsule is the most richly innervated section of the joint suggesting these
      nerves should be the main targets for hip analgesia.
    

Intervention name(s): erector spinae plane block; pericapsular nerve group block
Intervention type(s): Procedure; Procedure
Intervention description(s): the patient will be placed in the lateral position with the surgical side up for performing erector spinae plane block. After skin preparation, superficial (5-12 MHz) ultrasound transducer will be placed in a longitudinal orientation 1-2cm lateral to the midline at the sacral level. The L2 level will be identiﬁed by counting upward from the sacrum. Following identiﬁcation of the erector spinae muscle (ESM) and transverse process, a 21 G needle will be inserted deep to the erector spinae muscle (ESM) in a cranio-caudal direction. After negative aspiration, the correct needle position will be conﬁrmed with the administration of 0.5-1ml LA. A total volume of 0.5 mL/kg local anesthetic solution will be injected interfascial plane between erector spinae muscle and transverse process for block performance.; the patient will be in supine position. The ilio-pubic eminence (IPE), the iliopsoas muscle and tendon, the femoral artery, and pectineus muscle will be visualized using a linear ultrasound probe. A 22-gauge, 50-mm needle will be introduced in a lateral to medial fashion in an in-plane approach to place the tip of the needle in the musculofascial plane between the psoas tendon anteriorly and the pubic ramus posteriorly. Following negative aspiration, a total volume of 0.5 mL/kg local anesthetic solution will be injected.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Supportive Care