Lumbar Paravertebral in Hernia Surgery
Condition: Postoperative Pain
MeSH terms: Pain, Postoperative
Study type: Interventional

Summary: 
      An inguinal hernia is one of the most common disorders requiring surgical repair in
      pediatrics. The effective treatment of postoperative pain in infants and children is
      challenging. Although the use of opioid analgesics is generally safe, adverse effects occur
      frequently, so the use of alternative analgesic techniques when available to improve
      postoperative analgesia while limiting opioid-related adverse effects, that is why there is
      an increase in the use of regional anesthetic techniques in infants and children.
    

Detailed description: 
      Different anesthetic regional techniques can be used for anesthesia and analgesia of the
      lower abdominal surgeries such as caudal, spinal, epidural, transversus abdominis plane
      block, ilioinguinal nerve block, lumbar plexus block, the field block and abdominal
      paravertebral block. The use of regional anesthesia with ultrasound guidance can help
      decrease complications of regional blocks.

      In the lumbar area, the lumbar paravertebral space is a potential space formed by the
      vertebral bodies, intervertebral discs and intervertebral foramina medially, the psoas major
      muscle anterolaterally and the erector spinae muscles, the transverse process and
      intertransverse ligaments posteriorly. There is no costotransverse ligament in the lumbar
      region. The lumbar spinal nerve roots run through the paravertebral space then continue
      through the psoas major muscle where they form the lumbar plexus.The spinal nerves in this
      space are devoid of a fascial sheath making them exceptionally susceptible to local
      anesthetics. The diaphragm and psoas muscle separate the thoracic and lumbar paravertebral
      areas; however, communication may occur via the medial and lateral arcuate ligaments of the
      diaphragm.

      Field block can be done by subcutaneous injection of a local anesthetic in an area bordering
      on the field to be anesthetized. It is safe, simple, effective, and economical, without post
      anesthesia side effects. Furthermore, local anesthesia administered before the incision
      produces longer postoperative analgesia because of local infiltration, theoretically,
      inhibits the build-up of local nociceptive molecules, and therefore, there is better pain
      control in the postoperative period.

      The aim of this study is to compare the analgesic and autonomic effects of unilateral
      abdominal ultrasound guided paravertebral block with field block in pediatric inguinal hernia
      surgery.

      This study hypothesizes that unilateral abdominal ultrasound guided paravertebral block may
      be more superior to field block in reducing intra and postoperative pain in the pediatric
      inguinal hernia. The analgesic efficacy and duration of ultrasound (US) guided unilateral
      lumbar paravertebral block and field block were compared when dexmedetomidine and epinephrine
      were added as adjuvants to bupivacaine.
    

Intervention name(s): Lumbar paravertebral group; The field block group
Intervention type(s): Drug; Drug
Intervention description(s): A mixture of 0.5 ml /kg bupivacaine (0.25%), and 0.5µg/Kg dexmedetomidine and Epinephrine 5 microgram/ ml.; A mixture of 0.5 ml /kg bupivacaine (0.25%), and 0.5µg/Kg dexmedetomidine and Epinephrine 5 microgram/ ml.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Supportive Care