Ultrasound Guided Subgluteal Sciatic Nerve Block Versus Caudal Analgesia for Cerebral Palsy Patients Undergoing Lower Limb Corrective Surgeries
Condition: Postoperative Pain
MeSH terms: Cerebral Palsy
Study type: Interventional

Summary: 
      Both caudal and peripheral nerve blocks are widely used for postoperative analgesia in
      pediatric population .The safety of both techniques has been documented especially after the
      application of ultrasound guidance for their performance. Patients with cerebral palsy
      usually require lower limb orthopedic surgeries,that extend from minor soft tissue releases,
      like tenotomies, tendon lengthening or transfer, to major osteotomies for correction of their
      limb deformities.

      Study objective: to compare the efficacy of ultrasound guided caudal block with subgluteal
      sciatic nerve block for postoperative pain control in pediatric patients with cerebral palsy
      who will undergo soft tissue surgeries for knee and ankle deformities correction.

      Methods: This study patients will be randomly distributed to 2 Groups to receive either US
      guided caudal block or US subgluteal sciatic nerve block after induction of general
      anesthesia.
    

Detailed description: 
      After proper preoperative patients' anesthesia assessment; the study patients (15 per each
      group) will receive general anesthesia with either intravenous induction or inhalational
      induction if uncooperative under full monitoring of hemodynamics, temperature and oxygen
      saturation.

      In caudal group : Patients will be positioned in lateral decubitus and their sacral hiatus
      will be palpated under the scanning of the ultrasound using high frequency linear probe then
      approached via 5 cm block needle that pierce the sacrococcygeal ligament then will be
      advanced to caudal canal under ultrasound guidance after which Marcaine 0.25% (1 ml/kg) will
      be administered in increments.

      In subgluteal sciatic group : Patients will be positioned in lateral decubitus and the
      ultrasound scanning for the sciatic nerve in the subgluteal region will be started between
      the two bony landmarks (greater trochanter and ischial tuberosity ) using high frequency
      linear probe then approached via 5 cm block needle under ultrasound guidance after which
      Marcaine 0.25% (0.3 ml/kg) will be administered in increments .

      Anesthesia will be maintained with sevoflurane inhalational anesthesia and incremental
      rocuronium and fentanyl for muscle relaxation and intraoperative analgesia respectively .
      Muscle relaxation will be reversed at the end of surgery by atropine-neostigmine combination
      and patients will be extubated fully awake. Postoperative analgesia in the form of
      intravenous paracetamol 15 mg/kg will be administered if revised FLACC(face,legs,activity,cry
      and consolability) scores are ≥ 4 and intravenous infusion of ketorolac 0.5 mg/ kg will be
      given if pain persisted for 15 minutes after paracetamol injection
    

Intervention name(s): ultrasound guided Subgluteal sciatic nerve block; ultrasound guided Caudal block
Intervention type(s): Procedure; Procedure
Intervention description(s): Patients will be positioned in lateral decubitus and the ultrasound scanning for the sciatic nerve in the subgluteal region will be started between the two bony landmarks (greater trochanter and ischial tuberosity ) using high frequency linear probe then approached via 5 cm block needle under ultrasound guidance after which bupivacaine 0.25% (0.3 ml/kg) will be administered in increments .; Patients will be positioned in lateral decubitus and their sacral hiatus will be palpated under the scanning of the ultrasound using high frequency linear probe then approached via 5 cm block needle that pierce the sacrococcygeal ligament then will be advanced to caudal canal under ultrasound guidance after which bupivacaine 0.25% (1 ml/kg) will be administered in increments.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Prevention