TFPB vs QLB III in Infra-umbilical Pediatric Surgeries

Study Overview
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Brief Summary
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Regional anesthetic techniques; they reduce postoperative morbidity, provide early mobilization and provide great advantages by significantly reducing the need for narcotic analgesics. Regional anesthetic techniques are widely used in our clinic for postoperative analgesia, especially in infants and children. In patients undergoing lower abdominal surgery, postoperative analgesia is usually provided by systemic opioids and neuraxial methods. Complications such as sedation, respiratory depression, itching, nausea, vomiting and possible paraplegia or bleeding of neuraxial methods due to the use of opioids seem to be the biggest disadvantages of these two methods. Transversalis fascial plane (TFP) block is a regional anesthesia technique that provides intraoperative and postoperative analgesia as an alternative to caudal and epidural analgesia, especially in children. Transversalis fascial plane (TFP) block was first described in 2009. TFP block has been shown to be effective as an alternative to epidural analgesia and as part of a multimodal postoperative analgesic approach in lower abdominal and pelvic surgeries in children. Quadratus lumborum block (QLB) is a widely used regional anesthesia technique. It is used in pediatric patients to reduce postoperative pain in supraumbilical or infraumbilical surgeries. As a common result of all approaches, the main effect in quadratus lumborum block is anesthesia of the lateral cutaneous branches. In our center, the investigators have been using both methods, alone or in combination, routinely for a long time, and the investigators aim to compare the two methods in this study. This study consists of comparing two domain blocks known as part of multimodal analgesia.

Detailed Description
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Transversalis fascial plane block and quadratus lumborum block are performed under general anesthesia just before the surgical incision, unless there are contraindications for the procedure for every patient scheduled for elective infraumbilical surgery in our center. In our study, patients will be divided into 2 groups and the effectiveness of trunk plan blocks, which are part of multimodal analgesia, will be compared. In the first group there will be patients who underwent transversalis fascial plane block (TFPB) alone, and in the second group there will be patients who underwent type III quadratus lumborum block (QLB). Post-operative pain scores with the Face, Leg, Activity, Cry, Consolability (FLACC) score will be recorded in 2-6-12-24th hours. Between both groups, postoperative analgesia need, time of analgesia need, presence of nausea and vomiting, surgeon and parent satisfaction will be followed up and recorded. All patients are operated under general anesthesia. General anesthesia is maintained with inhalation anesthesia. At the end of the surgery, the patient is awakened and taken to the recovery unit. In this prospective randomized study, the investigators will compare the efficacy of these two blocks, which are part of multimodal analgesia, with postoperative analgesic consumption. Postoperative patient comfort, complications, demographic findings will be used as data.

Official Title
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Investigation of the Effects of Transversalis Fascial Plane Block and Quadratus Lumborum Plane Block Applied in Pediatric Infra-umbilical Surgeries on Postoperative Pain and Analgesic Consumption

Conditions
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Surgical Procedure, Unspecified

Intervention / Treatment
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* Other: Transversalis Fascial Plane Block
* Other: Quadratus Lumborum Plane Block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Parental acceptation to participate and signed written consent Aged between 3 and 7 American Society of Anesthesiologists (ASA) physical score I or II Elective infra umbilical surgery Exclusion Criteria: Parental refusal to participate Known allergy to local anesthetics American Society of Anesthesiologists (ASA) physical score ≥ III Coagulopathy Hypersensitivity history to the agents to be used Local infections Known anatomically or systemic disorder Known growth and developmental retardation

Ages Eligible for Study
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Minimum Age: 3 Years
Maximum Age: 7 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: The patients will be divided randomly by a computer-generated randomization table into two equal groups.
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Transversalis Fascial Plane Block Group<br>Patients will receive ultrasound-guided transversalis fascial plane block | Other: Transversalis Fascial Plane Block<br>* Patients will receive ultrasound-guided transversalis fascial plane block with 0,3 ml/kg of bupivacaine 0.25% just after general anesthesia induction<br>* Other names: TFPB;|
| Active Comparator: Quadratus Lumborum Block Group<br>Patients will receive ultrasound-guided quadratus lumborum block | Other: Quadratus Lumborum Plane Block<br>* Patients will receive ultrasound-guided quadratus lumborum plane block with 0,3 ml/kg of bupivacaine 0.25% just after general anesthesia induction<br>* Other names: QLB III;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total dose of paracetamol consumption | Total dose of paracetamol consumption in the ward | in the first 24 hour postoperatively | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| FLACC score | Postoperative FLACC score in the ward. FLACC score is a 10 point behavioral face, leg, activity, cry, consolability pain scale with a minimum score of 0 and a maximum of 10. | in the first 24 hour postoperatively | 
| The 1st time to rescue analgesic need | The time to ask for postoperative analgesia is the time from the end of operation to patient reporting FLACC score ≥ 4. | in the first 24 hour postoperatively | 
| Number of postoperative nausea and vomiting | Postoperative nausea and vomiting presence | in the first 24 hour postoperatively | 
| Parental satisfaction level | Parental satisfaction level will be evaluated using a five-point Likert scale 5= very satisfied 4= satisfied 3= neutral 2= dissatisfied 1= very dissatisfied | in the first 24 hour postoperatively | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Analgesia, Transversalis Fascial Plane Block, Quadratus Lumborum Block, Pediatric, Ultrasound Guidance