Lumbar Paravertebral in Hernia Surgery
Comparison Between Lumbar Paravertebral and Field Blocks in Pediatric Inguinal Hernia Surgery.
研究概览
详细说明
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.
研究类型
注册 (实际的)
阶段
- 不适用
联系人和位置
学习地点
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Dakahlia
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Mansoura、Dakahlia、埃及、35516
- Mansoura University Children's Hospital
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参与标准
资格标准
适合学习的年龄
接受健康志愿者
有资格学习的性别
描述
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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学习计划
研究是如何设计的？
设计细节
- 主要用途：支持治疗
- 分配：随机化
- 介入模型：并行分配
- 屏蔽：单身的
武器和干预
参与者组/臂 |
干预/治疗 |
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有源比较器：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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有源比较器：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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研究衡量的是什么？
主要结果指标
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
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The total dose of analgesics required in the post-operative periods
大体时间：24 hours postoperatively
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Fentanyl in microgram.
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24 hours postoperatively
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次要结果测量
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
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Modified Faces Legs Activity Cry Consolability Revised pain Scale
大体时间：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
大体时间：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
大体时间：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.
大体时间：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
大体时间：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)
大体时间：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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合作者和调查者
研究记录日期
研究主要日期
学习开始 (实际的)
初级完成 (实际的)
研究完成 (实际的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (实际的)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
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