Quadratus Lumborum Block for Pediatric Hip Surgery

NCT04292782 | Completed

• 1 other identifier: CE-IMKO 104/2019
• Study Type: interventional
• Target: 40
• Locations: 1 country
• Sites: 1

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.

Conditions

Hip Dislocation, Congenital; Postoperative Pain; Anesthesia

Keywords

hip dislocation; regional anesthesia; surgery

Outcome Measures

Primary Outcomes (1)

• analgesics consumption

  total tramadol consumption

  day one

Secondary Outcomes (2)

• postoperative pain score

  day one

• analgesic rescue

  Day one

Study Arms (2)

CAUDAL BLOCK

ACTIVE COMPARATOR

Sonosite machine (M-Turbo) equipped with a large bandwidth, a multifrequency linear probe (6-19 MHz) and needle of diameter and length respectively between 22G and 25G, 35mm and 40mm according to the child's size (Braun).The patient is positioned laterally with their hips flexed to 90°. The sacral hiatus is forming with the two posterior superior iliac spines an equilateral triangle. The puncture is performed between the two sacral cornuae. The sacrococcygeal ligament gives a perceptible 'pop' when crossed. After crossing the sacro-coccygeal ligament, the needle is redirected 30° to the skin surface, and then advanced a few millimeters into sacral canal. After verifying absence of spontaneous reflux of blood or cerebrospinal fluid, slowly injection of Ropivacaine 0.25% 1ml/ kg

Procedure: caudal block

anterior Quadratus lumborum block

EXPERIMENTAL

Sonosite machine (M-Turbo) equipped with a large bandwidth, a multifrequency linear probe (6-19 MHz) and a 22G, 50-mm, insulated facet type needle (BBraun Stimuplex Ultra 360°). Patients were placed in the lateral position, a probe was placed transversely to the abdominal flank. The needle was inserted using an in-plane technique and was preceded further into the fascia between the QLM and PM. Following confirmation of the correct space with the administration of 0.5-1 ml local anesthetic, block was induced with 1 ml/kg, 0.25% Ropivacaine,

Procedure: anterior Quadratus lumborum block

Interventions

anterior Quadratus lumborum block PROCEDURE

ultrasound anterior quadratum lumborum block with 1 ml/kg 0.2% ropivacaine

anterior Quadratus lumborum block

caudal block PROCEDURE

ultrasound guided caudal block with 1 ml/kg 0.2% ropivacaine

CAUDAL BLOCK

Eligibility Criteria

• Age: 2 Years - 7 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17)

You may qualify if:

• 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

You may not qualify if:

• 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

Sponsors & Collaborators

• University Tunis El Manar: lead
• Institut Kassab d'Orthopédie: collaborator

Study Sites (1)

Institut Kassab D'Orthopedie

Tunis, 2010, Tunisia

Location

MeSH Terms

Conditions

Hip Dislocation, Congenital; Pain, Postoperative; Hip Dislocation

Condition Hierarchy (Ancestors)

Developmental Dysplasia of the Hip; Musculoskeletal Abnormalities; Musculoskeletal Diseases; Congenital Abnormalities; Congenital, Hereditary, and Neonatal Diseases and Abnormalities; Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Pain; Neurologic Manifestations; Signs and Symptoms; Joint Dislocations; Joint Diseases; Wounds and Injuries; Hip Injuries

Study Officials

• khaireddine Raddaoui, MD

  Tunis El Manar University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: TRIPLE
• Who Masked: PARTICIPANT, INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor

Study Record Dates

• First Submitted: February 23, 2020
• First Posted: March 3, 2020
• Study Start: March 31, 2020
• Primary Completion: March 30, 2021
• Study Completion: December 31, 2021
• Last Updated: February 13, 2024

Record last verified: 2024-02

Locations

TU (1)