الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 181 |  |  |
| | | from | 181 | | |
Abstract
Surgical repair of the hip can be extremely painful and is associated with considerable postoperative pain in children despite the use of systemic opioids. These patients may benefit from neuraxial analgesia in adjunction with general anesthesia. The reported advantages of this technique include decreased opiate exposure, decreased time in the post-anesthesia recovery room, decreased hospital stay, reducing the post-operative morbidity and providing early mobilization. Caudal epidural block has been the widely used regional anesthesia method, especially in pediatric surgery, to provide intraoperative and postoperative analgesia by affecting the region between T10 and S5 dermatomes in surgeries below the umbilical level. In conventional single shot caudal block, there is a risk of dural or vascular puncture when the needle is passing through sacral canal. Other complications are the soft tissue bulging, intraosseous injections and systemic toxicity. The usage of ultrasonography in regional anesthesia has many advantages as it is helpful for visualization of the sacral hiatus, SCL, epidural space and the distribution of the local anesthetic agent within the epidural space. Therefore, this significantly increases the block success. Erector Spinae Plane block (ESPB) has also been reported for the management of other causes of acute and postoperative pain. Pediatric regional anesthesiologists have adopted ESPB due to their relative ease of placement and potential safety. In this ultrasound-guided (USG) technique, local anesthetic (LA) is applied between the erector spinae muscle and the • transverse process of the lumbar vertebra leading to spread of LA cephalad, caudally and through the paravertebral space. Therefore, this study was conducted to compare the efficacy and safety of ultrasound guided erector spinae block, ultrasound guided caudal block and conventional caudal block for pain management after pediatric hip surgery. This prospective randomized controlled double blinded study was carried out on 105 children aged 4-12 years, admitted for unilateral elective hip surgery of both sex, ASA physical activity I, II. Patients were divided equally into three groups: each of 35 patients: • group I: Conventional caudal block (CC): blind technique. • group II: Ultrasound-guided caudal block (UC). • group III: Ultrasound guided erector spinae plane Block (ESPB): at the level of the transverse process of the second lumbar vertebrae (L2). Measurements of our study included: Demographic data, Hemodynamic Parameters (MAP & HR) were recorded preoperatively, before block performance at T 0, intraoperatively at 15 and 30 minutes, then every 30 min till the end of surgery and after surgery at T (PACU, 2, 4, 6, 8, 12, 18, 24 h) where T PACU= time at 30 min after end of surgery before discharging from the post anesthesia care unit (PACU). Adverse events, FLACC Scale assessed after surgery over 24 hours, Time to first rescue analgesia, Total analgesic consumption (Paracetamol or Tramadol) over 24 h after surgery, Success rate of the block, Block performing time and degree of parents‟ satisfaction were recorded. • Summary of our results: • Demographic data (age, gender, weight, height, BMI, duration of surgery (min) and type of hip pathology were insignificantly different among the three groups. • Intraoperative heart rate was insignificantly different at all time measurements among the three groups and within the same group (P value >0.05). Intraoperative mean arterial pressure (mmHg) was insignificantly different at all time measurements among the three groups and within the same group (P value >0.05). • Postoperative heart rate was insignificantly different at PACU, 2, 6, 12, 18 and 24 hours among the three groups. Postoperative heart rate was significantly higher after 4 hours in groups CC and UC compared to group ESPB (P value =0.017, 0.029 respectively), was insignificantly different between groups CC, UC. Postoperative heart rate was significantly higher after 8 hours in group ESPB compared to groups CC and UC (P value= 0.012, 0.033 respectively), was insignificantly different between groups CC, UC. • Postoperative MAP was insignificantly different at PACU, 2, 6, 12, 18 and 24 hours among the three groups. Postoperative MAP was significantly higher after 4 hours in groups CC and UC compared to group ESPB (P values =0.01, 0.031 respectively), was insignificantly different between groups CC, UC. Postoperative MAP was significantly higher after 8 hours in group ESPB compared to groups CC and UC (P value= 0.004, 0.006 respectively), was insignificantly different between groups CC, UC. • FLACC (Face, Legs, Activity, Cry, Consolability) scale was insignificantly different at PACU, 2, 6, 12, 18 and 24 hour among the three groups. FLACC scale was significantly higher after 4 hours in • groups CC and UC compared to group ESPB (P values <0.001), was insignificantly different between groups CC, UC. FLACC scale was significantly higher after 8 hours in group ESPB compared to groups CC and UC (P value<0.001), FLACC was insignificantly different between groups CC, UC. • Time to first rescue analgesic requirement was significantly delayed in group ESPB compared to groups CC and UC (P value <0.001) and was insignificantly different between groups CC and UC. • Total tramadol consumption was significantly lower in group ESPB compared to groups CC and UC (P value<0.001) and was insignificantly different between groups CC and UC. • Total paracetamol consumption was insignificantly different among the three groups. • Block performing time was 3.31 ± 0.76 vs. 3.74 ± 0.78 vs. 3.51 ± 0.66 min in group CC, group UC and group ESPB respectively. It was insignificantly different among the three groups (P value =0.128). • Regarding success rate of block, it was successful in 32 (91.4%), 33 (94.3%) and 33 (94.3%) in group CC, group UC and group ESPB respectively. It was insignificantly different among the three studied groups. • Side effects (bradycardia, hypotension, PONV, urinary retention) were insignificantly different among the three groups. Local anesthetic systemic toxicity (LAST) didn‟t occur in any patient in all studied groups. • Parents‟ satisfaction was insignificantly different among the three groups.