Lumbar Paravertebral in Hernia Surgery
Comparison Between Lumbar Paravertebral and Field Blocks in Pediatric Inguinal Hernia Surgery.
Visão geral do estudo
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Intervenção / Tratamento
Descrição detalhada
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.
Tipo de estudo
Inscrição (Real)
Estágio
- Não aplicável
Contactos e Locais
Locais de estudo
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Dakahlia
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Mansoura, Dakahlia, Egito, 35516
- Mansoura University Children's Hospital
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Critérios de participação
Critérios de elegibilidade
Idades elegíveis para estudo
Aceita Voluntários Saudáveis
Gêneros Elegíveis para o Estudo
Descrição
Inclusion Criteria:
- Patients subjected to an elective unilateral inguinal hernia repair.
- American Society for Anesthesiologists physical status grades I and II.
Exclusion Criteria:
1. Parental refusal. 2. Neuromuscular diseases (as myopathies, myasthenia gravies, etc.) 3. Hematological diseases, bleeding or coagulation abnormality. 4. Psychiatric diseases. 5. Local skin infection and sepsis at the site of the block. 6. Known intolerance to the study drugs.
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Plano de estudo
Como o estudo é projetado?
Detalhes do projeto
- Finalidade Principal: Cuidados de suporte
- Alocação: Randomizado
- Modelo Intervencional: Atribuição Paralela
- Mascaramento: Solteiro
Armas e Intervenções
Grupo de Participantes / Braço |
Intervenção / Tratamento |
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Comparador Ativo: Lumbar paravertebral group
After general anesthesia, the patient is placed prone.
To establish the level of the block, we used US-counting of vertebrae.
After determining the lumbar one level, the block performed at a parallel line 2 cm lateral to the spinous process, the transducer is moved until the corresponding transverse process is identified.
Utilizing an in-plane approach from lateral to medial, a spinal needle is advanced until contact with the transverse process.
The needle is withdrawn and redirected caudally under the transverse process helped by the loss of resistance technique.
the solution is slowly injected after negative aspiration for blood.
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A mixture of 0.5 ml /kg bupivacaine (0.25%), and 0.5µg/Kg dexmedetomidine and Epinephrine 5 microgram/ ml.
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Comparador Ativo: The field block group
The ilioinguinal nerve block was done at one fingerbreadth from the anterior superior iliac spine in a line with the pubic tubercle, The injection was done after the bob of the needle after passing the external oblique aponeurosis and muscle and 5ml of the solution is injected.
The rest of the solution is injected in the incision line.
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A mixture of 0.5 ml /kg bupivacaine (0.25%), and 0.5µg/Kg dexmedetomidine and Epinephrine 5 microgram/ ml.
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O que o estudo está medindo?
Medidas de resultados primários
Medida de resultado |
Descrição da medida |
Prazo |
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The total dose of analgesics required in the post-operative periods
Prazo: 24 hours postoperatively
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Fentanyl in microgram.
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24 hours postoperatively
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Medidas de resultados secundários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
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Modified Faces Legs Activity Cry Consolability Revised pain Scale
Prazo: postoperative at 1, 2, 4, 8,16, 24 hours.
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pain score of 5 items (Faces, Legs, Activity, Cry, Consolability) each of 0, 1, or 2 points.
0= express no pain, 1= mild pain, 2= the highest pain indicator.
A total score 0 = Relaxed and comfortable.
1-3 = Mild discomfort.
4-6 = Moderate pain.
7-10 = Severe pain.
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postoperative at 1, 2, 4, 8,16, 24 hours.
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Mean Blood pressure
Prazo: Basal preoperative, during incision, 30 minutes, 60 minutes intraoperatively, postoperative at 1, 2, 4, 8,16, 24 hours.
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millimeter mercury
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Basal preoperative, during incision, 30 minutes, 60 minutes intraoperatively, postoperative at 1, 2, 4, 8,16, 24 hours.
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Heart rate
Prazo: Basal preoperative, during incision, 30 minutes, 60 minutes intraoperatively, postoperative at 1, 2, 4, 8,16, 24 hours.
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beat/minutes
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Basal preoperative, during incision, 30 minutes, 60 minutes intraoperatively, postoperative at 1, 2, 4, 8,16, 24 hours.
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Modified Ramsay sedation scale.
Prazo: postoperative at 2, 4, 6, 12, 16, 24 hours.
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a scale from (1- 6), 1 = anxious; 2 = oriented & tranquil; 3 = sedated, but responds to commands; 4 = asleep, brisk glabellar reflex or response to loud noise; 5 = asleep, slugglish glabellar reflex or response to loud noise; 6 = asleep with no response to painful stimulus
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postoperative at 2, 4, 6, 12, 16, 24 hours.
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Parents' satisfaction score
Prazo: postoperative after 24 hours.
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in a visual analogue score from (0-10), 0= minimal satisfaction, 10 = the highest satisfaction.
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postoperative after 24 hours.
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Adverse effects including nausea and vomiting, bradycardia (heart rate less than 60 beat/minute)
Prazo: postoperatively in the first 24 hours.
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percent
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postoperatively in the first 24 hours.
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Colaboradores e Investigadores
Patrocinador
Datas de registro do estudo
Datas Principais do Estudo
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Conclusão Primária (Real)
Conclusão do estudo (Real)
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Enviado pela primeira vez
Enviado pela primeira vez que atendeu aos critérios de CQ
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Última Atualização Postada (Real)
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Última verificação
Mais Informações
Termos relacionados a este estudo
Termos MeSH relevantes adicionais
Outros números de identificação do estudo
- MS/16.06.19
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Descrição do plano IPD
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- SEIVA
- CSR
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