Serratus Anterior Plane Block Versus Erector Spinae Plane Block. for Thoracotomy in Pediatric Patients

Study Overview
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Brief Summary
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This randomized controled trial is designed to compare efficacy and safty of serratus anterior plane block versus erector spinae plane block for thoracotomy in pediatric patients.

Official Title
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Serratus Anterior Plane Block Versus Erector Spinae Plane Block For Thoracotomy In Pediatric Patients: a Randomised Clinical Trial

Conditions
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Anesthesia

Intervention / Treatment
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* Procedure: Fascial plane block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria Age 1 to 10-year-old ASA I, II, and II Exclusion Criteria Patients whose parents or legal guardians refusing to participate. Preoperative mechanical ventilation. Preoperative inotropic drug infusion. Known or suspected coagulopathy.

Ages Eligible for Study
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Minimum Age: 1 Year
Maximum Age: 10 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
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Serratus Anterior Plan block<br>The SAPB was performed in the operative room (OR) after anesthesia induction using the same ultrasound machine (SonoSite) and linear ultrasound transducer 8- 12 Hz. The patient was positioned in a lateral position with the operative side up and arm flexed forward; then, a linear ultrasound transducer was placed in a sagittal plane over the mid-clavicular line of the thoracic cage. Then, moving inferior-lateral direction till the fifth rib was identified in the mid-axillary line. The following structures were recognized: the rib, pleura, teres major muscle (superior), latissimus dorsi muscle (superficial and posterior), and serratus muscles muscle (deep and inferior). Under complete sterile conditions, a 22-gauge echogenic needle was introduced in-plane with respect to the ultrasound probe targeting the plane deep to the serratus anterior muscle. Then, 0.4 ml/kg of 0.25% bupivacaine was injected with continuous ultrasound guidance. | Procedure: Fascial plane block<br>* Serratus anterior plane block<br>|
| Active Comparator: Erector spinae plane block<br>Patients in Group ESPB receive US erector spinae plane block by injecting 0.4ml/kg (bupivacaine 0.25%). Under strict aseptic precautions, The T3 spinous process is located by palpating and counting down from the C7 spinous process. A high-frequency 12 MHz linear ultrasound transducer is placed in a longitudinal orientation 3 cm lateral to the T3 spinous process corresponding to the T2 transverse process. Three muscles; trapezius (uppermost), rhomboids major (middle), and erector spinae (lowermost) will be identified superior to the hyperechoic transverse process.Using an in-plane approach a 22 G needle is inserted in caudal-cephalad direction until the tip is deep to erector spinae muscle. Correct needle tip location is confirmed by injecting 3 mL of normal saline and visualizing the linear LA spread (i.e., hydrodissection) in the fascial plane between the erector spinae muscle and the transverse process. Then, bupivacaine is injected, and visualizing the fascial plane. | Procedure: Fascial plane block<br>* Serratus anterior plane block<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| post-operative fentanyl consumption | amount of fentanyl in mic consumed in the 24 hours postoperatively | 9 month | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| intraoperative fentanyl consumption | total dose of fentanyl given during the surgical procedure | 24 hours | 
| FLACC score at 1,2,4,8,12,24 hours postoperatively | FLACC score ( Face Leg Activity Cry Consolability ) it is pediatric observational 10-point scale Face, Leg, Activity, Cry, Consolability (FLACC) pain score. each point is given score between 0 and 2. the maximum score is 10 the lowest is 0 | 24 hours | 
| patient satisfaction | satisfaction in numeric scale from1 to 5. 1 express the worst, and 5 express the best. | 24 hours | 
| RASS score | sedation score | 24 hours | 
| time of first rescue analgesi | duration of postoperative analgesia | 24 hours | 
| Quality of Recovery-15 (QoR-15) scale at 24 h postoperatively. | Quality of Recovery-15 (QoR-15) scale at 24 h postoperatively. | 24 hours | 
| PONV | post operative nausea and vomiting | 24 hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Erector spinae block, Pediatric, serratus anterior plane block, Thoracotomy