Efficacy and Safety of Quadratus Lumborum Block Versus Pericapsular Nerve Group Block in Pediatric Hip Surgery
Condition: Pain, Postoperative; Developmental Dislocation of Hip
MeSH terms: Hip Dislocation; Hip Dislocation, Congenital; Developmental Dysplasia of the Hip; Pain, Postoperative
Study type: Interventional

Summary: 
      Surgical procedure including hip joint surgery is extremely painful and associated with
      considerable postoperative pain in children despite the use of systemic opioids.

      Caudal block is a common method used for perioperative pain relief in pediatric lower limb
      surgeries but carries some complications.

      Some novel techniques of regional anesthesia were explored including the quadratus lumborum
      block (QLB), lumbar plexus block, and recently Pericapsular nerve group (PENG) block.

      The objective of the current trial is primarily to assess the analgesic efficacy of
      ultrasound-guided trans-muscular QLB versus ultrasound-guided PENG block in pediatric
      patients undergoing open hip surgery for developmental dysplasia of the hip (DDH)
    

Detailed description: 
      During the pre-anesthesia check-up visit, the proposed intervention will be discussed with
      the eligible participant's parents or caregivers including data about the aim, the
      advantages, and the expected side effects, and then detailed informed consent will be
      obtained before recruitment and randomization.

      All participants will be premedicated with 0.5mg/kg oral midazolam about 30min before being
      admitted to the operating room. The routine standard monitoring including electrocardiography
      (ECG), non-invasive blood pressure (NIBP, oxygen saturation (SpO2), temperature probe, and
      end-tidal CO2 (EtCO2) will be applied to all participants. Induction of anesthesia will be
      performed using a face mask with sevoflurane inhalation in oxygen starting with 2% up to 8%
      till complete loss of consciousness after that peripheral intravenous (IV) line will be
      secured where fentanyl 1 μg/kg and followed by cisatracurium 0.15mg/kg to facilitate
      orotracheal intubation. Anesthesia will be maintained by using isoflurane 1.2-1.5% in oxygen
      air mixture 50%:50% in addition to incremental cisatracurium 0.03mg/kg.

      After induction of general anesthesia, the eligible participants will be randomly assigned to
      one of two equal groups using an allocation sequence which will be generated using permuted
      block randomization technique and the block size will be variable.

      In both interventional groups of participants, the assigned block will be performed after
      induction of general anesthesia by the same investigator who will have no further role in the
      study. Surgery will be started about 15 minutes after performing the block.

      Fentanyl 1μg/ kg will be administrated in the case of inadequate analgesia which is defined
      as an increase of heart rate (HR) and/or mean arterial blood pressure (MAP) more than 20%
      above the pre-operative values. At the end of the surgery, isoflurane will be switched off
      and extubation will be done after reversal of muscle relaxant with neostigmine 0.05 mg/kg and
      atropine 0.02 mg/kg where the participants will be transferred to the Post-Anesthesia Care
      Unit (PACU). Paracetamol (15 mg/kg) will be administered IV every 6 hours in all patients.
      Postoperative pain will be assessed by FLACC score (Face, leg, activity, cry, consolability).
      Morphine 0.1 mg /kg IV will be given as rescue analgesia if the FLACC score will be > 3.
      Postoperative HR and MAP will be recorded postoperatively at 2 h, 4, 8, 12, 24, and 48 hours.
    

Intervention name(s): TQL block; PENG block
Intervention type(s): Procedure; Procedure
Intervention description(s): Ultrasonography-guided quadratus lumborum block (QLB) where we will infiltrate local anesthetic solution adjacent to the anterolateral aspect of the quadratus lumborum muscle; Ultrasound-guided local anesthetic infiltration will be injected in the musculofascial plane between the psoas tendon anteriorly and the pubic ramus posteriorly
Other intervention name(s): transmuscular quadratus lumborum block; pericapsular nerve group block
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Prevention
Keywords: quadratus lumborum block; pericapsular nerve group block; developmental dysplasia of the hip; postoperative analgesia; pediatric; hip surgery