Clinical trial NCT04292782: Quadratus Lumborum Block for Pediatric Hip Surgery
Official title: Caudal Epidural Block Compared to Anterior Quadratus Lumborum Block for Pediatric Hip Surgery
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Hip Dislocation, Congenital
Postoperative Pain
Anesthesia
Keywords: hip dislocation
regional anesthesia
surgery
Lead sponsor: University Tunis El Manar
Sponsor class: OTHER
Collaborators: name: Institut Kassab d'Orthopédie
First posted: 2020-03-03
Enrollment: 40
Sex: ALL
Minimum age (years): 2
Maximum age (years): 7
Standard ages: CHILD
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: Caudal blockade (CB) is one of the most frequently performed regional anaesthetic techniques in children. It's an efficient way to offer perioperative analgesia for painful sub-umbilical interventions but with high incidence of motor block and urinary retention. In one study, psoas compartment block was associated with less morphine comsumption and prolonged duration of analgesia compared to single-shot caudal Block in small children undergoing open hip reduction/osteotomies. Ultasound guided anterior Quadratus lumborum block (AQLB) provides unilateral analgesia to the nerves between the psoas muscle (PM) and the quadratus lumborum muscle (QLM). The first pediatric study evaluating Quadratus lumborum block is encouraging .

The first pediatric study evaluating Quadratus lumborum block is encouraging. To the best of the investigator's knowledge, there are no previously published data comparing the AQLB with other regional techniques in infants undergoing hip surgery.

Detailed description: The aim of this prospective randomized study was to compare the analgesic effects between AQLB and CB in children undergoing unilateral open hip reduction/osteotomies for hip dislocation.

Patients were randomly assigned, into 1 of 2 groups, namely, group CB (n = 20) and group AQLB (n = 20).

Preoperatively all children were premedicated by using oral midazolam (0 .5mg/kg).

anesthesia was induced with 3 to 4% sevoflurane and 50% with 60% nitrous oxide in oxygen.Then fentanyl 3 μg/kg and Propofol 1 - 2mg/Kg were administered for anesthesia induction. Airway was secured with endotracheal tube placed in the mouth facilited by 0.15 mg/kg cistracurium. Anesthesia maintenance was performed with sevoflurane 2% in 50% nitrous oxide.

AQLB and CB were done with 1 ml/kg, 0.25% Ropivacaine (maximum dose limited to 20 ml)

Postoperative follow-up:

All patients received 15 mg/kg paracetamol before extubation. Tramadol 2 mg/kg intravenous was planned as rescue analgesia when CHEOPS score was more than 3. Supplemental IV tramado, 1 mg/kg could be added if necessary every 6 hours.

Eligibility criteria: Inclusion Criteria:

* Patients aged 2 to 7 years old
* Weight ≤ 20 Kg
* American Society of Anesthesiologists (ASA) physical status I or II
* Planned to undergo unilateral open hip reduction/osteotomies

Exclusion Criteria:

* Cerebral palsy with severe intellectual disability
* Coagulation disorders
* Local or general infection
* Allergy to amide local anesthetics.
* Progressive neurological disorders
* Parenteral refusal
* Spinal dysraphism
* Cutaneous anomalies (angioma, hair truft, naevus or a dimple)near to the puncture

Primary outcomes:
measure: analgesics consumption
timeFrame: day one
Secondary outcomes:
measure: postoperative pain score
timeFrame: day one
measure: analgesic rescue
timeFrame: Day one
Other outcomes:
Locations:
city: Tunis
country: Tunisia
facility: Institut Kassab D'Orthopedie
Study officials:
affiliation: Tunis El Manar University
name: khaireddine Raddaoui, MD
role: PRINCIPAL_INVESTIGATOR
References: