Transversus Abdominis Plane Block Versus Quadratus Lumborum Block in The Pediatric Population Undergoing Orchiopexy
Condition: Pain, Postoperative
MeSH terms: Pain, Postoperative
Study type: Interventional

Summary: 
      Transversus abdominis plane (TAP) and Quadratus lumborum (QL) blocks are used for the
      management of acute pain treatment, especially after the lower and upper abdominal surgeries.

      The TAP block which is one of the abdominal truncal blocks is performed with the blockage of
      the nerve group which innervates the anterior abdominal muscle wall layers. However, in QL
      block, the local anesthetic agent spreads through the abdominal wall and paravertebral space
      with the help of the perimuscular fascia to maintain the somatic analgesia.

      The investigators' aim in this study, to investigate the effect of the TAP and QL blocks on
      peroperative and postoperative analgesic consumption in children undergoing unilateral
      elective orchiopexy.
    

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 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 QL block to the first group and TAP block 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): Transversus abdominis plane block, Quadratus lumborum block
Intervention type(s): Procedure
Intervention description(s): The TAP block which is one of the abdominal truncal blocks is performed with the blockage of the nerve group which innervates the anterior abdominal muscle wall layers. However, in QL block, the local anesthetic agent spreads through the abdominal wall and paravertebral space with the help of the perimuscular fascia to maintain the somatic analgesia.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Other
Keywords: quadratus lumborum block; transversus abdominis plane block; pediatric patient; orchiopexy; regional anesthesia; pain