Ultrasound Guided Pericapsular Nerve Group Block Versus Quadratus Lumborum Block
Condition: Pediatric Postoperative Pain
MeSH terms: Pain, Postoperative
Study type: Interventional

Summary: 
      Hip surgeries in pediatrics consider as one of the common nowadays surgeries with sever
      postoperative pain so pain management is essential to decrease postoperative complications,
      early mobilization and hospital discharge. Traditional use of opioids is associated with many
      adverse effects such as sedation, dizziness, nausea, vomiting, constipation and respiratory
      depression.

      Previous studies reported that Quadratus Lumborum (QL) Block and Pericapsular Nerve Group
      (PENG) Block are effective postoperative analgesia in hip surgeries.

      In this study we will compare between QL block and PENG Block for effective postoperative
      analgesia to reduce opioids consumption and subsequently avoid opioid-related adverse
      effects, early mobilization and early hospital discharge.
    

Detailed description: 
      Developmental dysplasia of the hip (DDH) is a common disease of the pediatrics patients with
      a rate of incidence 3 to 5 per 1000 children and open surgical reduction of congenital hip
      dislocation (CHD) is commonly done in paediatrics.

      One of the most important challenges in pediatric hip surgeries is postoperative pain
      management which may result in impaired patient rehabilitation and prolonged
      hospitalizations.

      Opioids are commonly used for postoperative analgesia in various surgeries but their use is
      associated with many complications such as sedation, dizziness, nausea, vomiting,
      constipation and respiratory depression. Many types of peripheral nerve blocks, such as the
      femoral nerve block (FNB) and the lumbar plexus block (LPB), are used for lower limb
      surgeries as well as anterior quadratus lumborum block (QLB) and Pericapsular nerve group
      (PENG) block that provide effective postoperative analgesia in lower limb surgeries.

      Quadratus Lumborum (QL) block was first described by Rafael Blanco at the 2007 annual meeting
      of the European Society of Regional Anesthesia (ESRA). The basic concept of the QL block is
      the deposition of a local anesthetic solution adjacent to the anterolateral aspect of the QL
      muscle. The spread pattern obtained is similar to that of the landmark-based TAP block, in
      that there is subsequent extension into the thoracic paravertebral space. Borglum et al.
      originally described placing the needle tip anterior to the QL muscle using their
      transmuscular approach.

      This technique was later refined by applying a posterior approach, named the "Shamrock
      method" (with the erector spinae, QL, and psoas muscles as the leaves and the L4 transverse
      process as the stem). Administering local anesthesia between the QL and psoas muscles ensures
      a reliable spread into the thoracic paravertebral space.

      There are different quadratus lumborum blocks (anterior, posterior and lateral blocks) with
      different mechanisms of action according to injectate spread. However, there is insufficient
      evidence to recommend one approach and transducer positioning over another for individual
      patient populations and specific surgical types.

      Pericapsular nerve group (PENG) block is relatively a recent regional technique based on
      blocking the articular branches to the hip joint with a single injection and is used for
      perioperative analgesia in hip surgery.

      The pericapsular nerve group block (PENG) is a regional anesthetic technique described in
      2018, developed primarily in total hip arthroplasties (THA) for postoperative analgesia with
      motor sparing benefits. The block is thought to provide more complete analgesia to the hip by
      depositing local anesthetic within the myofascial plane of the psoas muscle and superior
      pubic ramus.
    

Intervention name(s): Quadratus lumborum (QL) block group; Pericapsular Nerve Group (PENG) block group
Intervention type(s): Procedure; Procedure
Intervention description(s): patient will receive 0.5 mg/kg of bupivacaine 0.25% through the quadratus lumborum block approach; patient will receive 0.5 mg/kg of bupivacaine 0.25% through the Pericapsular Nerve Group (PENG) block
Other intervention name(s): Group Q; Group P
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The patients will be divided randomly by a computer-generated randomization table into three equal groups
Masking: Triple (Participant, Care Provider, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Pericapsular Nerve Group Block; Quadratus Lumborum Block; postoperative analgesia; pediatric hip surgeries