Bilateral Ultrasound-Guided Intra Muscular Quadratus Lumborum Block Versus Trans Muscular Quadratus Lumborum Block for Peri-Operative Analgesia in Abdominal Surgeries in Pediatric Patients. A Comparative Controlled Randomized Study.
Condition: Pain, Acute
MeSH terms: Acute Pain
Study type: Interventional

Summary: 
      To compare between the intra muscular quadratous lamborum and the Trans muscular quadratous
      lamborum in pediatric population under going abdominal surgeries regards to first request of
      rescue analgesia, degree of pain relief, effect on hemo dynamic stability and incidence of
      complications.
    

Detailed description: 
      The investigators hypothesized that an ultrasound guided quadratous lamborum block would
      prove successful peri-operative analgesia for abdominal surgeries in pediatric patients, and
      that Intra muscular quadratous lamborum is non inferior to Trans muscular blockade with the
      advantage of being safer (away from the peritoneum and retroperitoneal organs) and with the
      assumption that sarcolemmal layer in pediatrics should not resist the diffusion of the
      injectant from within the muscle out, to reach the inter fascial plane where the targeted
      nerves are found and cause an efficient blockade.
    

Intervention name(s): Bilateral Ultrasound-Guided Transmuscular Quadratus Lumborum Block.; Bilateral Ultrasound-Guided intra smuscular Quadratus Lumborum Block.; Control
Intervention type(s): Procedure; Procedure; Procedure
Intervention description(s): A 22 G echogenic needle will be inserted in plane from the posterior (medial) end of the probe and directed for the fascial plane between the Quadratus Lumborum and the Psoa Major muscles through the Quadratus Lumborum muscle. Once the needle is confirmed in correct location, 1 mL of saline will be injected after negative aspiration. Then 0.5 mL/Kg of bupivacaine 0.25% will be injected. The spread of the injectate should be observed to distribute within this plane. This technique will be repeated to the other side.; A 22 G echogenic needle will be inserted in plane from ventral (lateral) edge of the probe and advanced until penetration of QL muscle fascia is observed. Once the needle is confirmed in correct location, 1 mL of saline will be injected after negative aspiration. Then 0.5 mL/Kg of bupivacaine 0.25% will be injected. The spread of the injectate should be observed to distribute within this plane. This technique will be repeated to the other side.; Conventional analgesia
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: age:5-12, American Society of Anesthesia I-III, abdominal laparoscopies, randomly allocated into one of the study groups, randomization sequence will be concealed in sealed envelopes with alphabetic codes. The identifiers will be attached to the opened envelopes and secured by dedicated person independent of randomization proceedings. Patients, parents and data analysts will be blinded to group assignments.
The groups:
group A → Trans muscular quadrous lamborum block (n=22)
group B → Intra muscular quadrous lamborum block (n=22)
group c → control (n=22) will receive conventional analgesia. Sample size Starting number of 22 patients for each group, Recalculation of the sample size will be carried out after studying 10 patients per group.
The alpha error is set at 0.05 and the study power is 0.95.
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Prevention