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Truncal Blocks for Pediatric With Developmental Dysplasia of the Hip Undergoing Open Reduction

Primary Purpose

Developmental Dysplasia of the Hip (DDH)

Status
Completed
Phase
Not Applicable
Locations
China
Study Type
Interventional
Intervention
transversalis fascia plane block
quadratus lumborum block
Sponsored by
Second Affiliated Hospital of Wenzhou Medical University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Developmental Dysplasia of the Hip (DDH) focused on measuring transversalis fascia plane block, quadratus lumborum block, ultrasound-guided, Developmental Dysplasia of the Hip, postoperative analgesia

Eligibility Criteria

2 Years - 10 Years (Child)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Pediatric patients aged between 2 years and 10 years with DDH,
  • scheduled for unilateral open reduction surgeries(Salter acetabular osteotomy,combined with proximal femoral rotation osteotomy)

Exclusion Criteria:

Patients will be excluded if they meet any of the following criteria:

  • patients with known allergy to local anaesthetics,
  • mental disability,
  • peripheral neuropathy,
  • a coagulopathy disorder,
  • localized infection in the area,
  • any reason cause reoperation.

Sites / Locations

  • Beijing Jishuitan Hospital
  • Second Affiliated Hospital of WenZhou Medical University

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

No Intervention

Arm Label

Group T

Group Q

Group C

Arm Description

Patients in transversalis fascia plane block group(Group T) will receive ultrasound-guided transversalis fascia plane block using0.3% ropivacaine(0.8 ml/kg) after general anesthesia

Patients in quadratus lumborum block group(Group Q) will receive ultrasound-guided quadratus lumborum block using0.3%ropivacaine(0.8 ml/kg).after general anesthesia.

Patients in the third group as control (Group C)receive no nerve block.Patients will be extubated based on clinical criteria.

Outcomes

Primary Outcome Measures

Change of FLACC pain scores at different time points (at rest and at movement)
using age-appropriate and validated tools (ie, the Face, Legs, Activity, Consolability Scale [FLACC] which evaluates the intensity of pain, ranged from 0-10, 0 means no pain and 10 means severe pain) to evaluate the change of pain scores at different time points which indirectly reflect the analgesia effect, both at rest and at movement.

Secondary Outcome Measures

The analgesia effects
The first time (hours after surgery) and the total numbers to press the analgesia pump (numbers) will be recorded.
the rescue analgesics
The number of doses of rescue analgesics (morphine 0.05 mg/kg) will be recorded.
complications
Postoperative nausea and vomiting (the numbers of participants with nausea and vomiting), hematoma (the number of participants with hematoma), nerve injury (the number of participants with nerve injury) will be recorded
Intra-operative opioid consumptions
intraoperative opioid consumption ((both fentanyl and remifentanil were converted into fentanyl equivalents).
PACU fentanyl consumptions
If a pain score was >3, the patient in the PACU would receive fentanyl (iv,1 μg·kg-1), while in the surgical ward morphine (iv,0.05 mg·kg-1) was administered.
PACU fentanyl rate
the number of patients who received the fentanyl in each group during the PACU
PACU stay
staying period in the PACU
Hospital stay
staying period in the hospital
Parental satisfaction score (0-10)
Satisfaction from all patients' guardians were surveyed with regard to the postoperative analgesia of their children at the time of the NCA/PCA pump removal

Full Information

First Posted
April 26, 2017
Last Updated
March 16, 2021
Sponsor
Second Affiliated Hospital of Wenzhou Medical University
Collaborators
Beijing Jishuitan Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT03189966
Brief Title
Truncal Blocks for Pediatric With Developmental Dysplasia of the Hip Undergoing Open Reduction
Official Title
Effect of Different Truncal Blocks Under Ultrasound-Guidance on Pain Management After Open Reduction of Pediatric Developmental Dysplasia of the Hip: a Randomized Trial
Study Type
Interventional

2. Study Status

Record Verification Date
March 2021
Overall Recruitment Status
Completed
Study Start Date
August 10, 2017 (Actual)
Primary Completion Date
July 1, 2018 (Actual)
Study Completion Date
July 1, 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Second Affiliated Hospital of Wenzhou Medical University
Collaborators
Beijing Jishuitan Hospital

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
The aim of the study is to evaluate the effectiveness of ultrasound-guided transversalis fascia plane block (TFPB) and quadratus lumborum block (QLB) on post-operative analgesia in pediatric patients with Developmental Dysplasia of the Hip (DDH)under going open reduction surgeries(Salter acetabular osteotomy,combined with proximal femoral rotation osteotomy).The effectiveness of TFPB/QLB for perioperative analgesia in lumbar nerves (L1) innervated surgery have been demonstrated in recent studies. However, this regional technique rarely applied to children.The objective of our research is to assess the quality of postoperative analgesia in pediatric patients who had received a preoperative TFPB/QLB for hip surgery.
Detailed Description
90 pediatric patients(age 2-10years) in the BeiJing Ji Shui Tan Hospital and The Second Affiliated Hospital of Wen Zhou Medical University with American Society of Anesthesiologists (ASA) physical status I or II, who are scheduled to undergo open reduction surgeries (Salter acetabular osteotomy,combined with proximal femoral rotation osteotomy)are selected and divided into 3 equal groups with 30 subjects.The consent forms are approved by the institutional Ethics Committee. Inclusion Criteria: Pediatric patients between 2 years to 10 years with DDH, scheduled for unilateral open reduction surgeries(Salter acetabular osteotomy,combined with proximal femoral rotation osteotomy). Exclusion Criteria:Patients will be excluded if participants meet any of the following criteria:patients with known allergy to local anaesthetics, mental disability, peripheral neuropathy, a coagulopathy disorder,localized infection in the area, and any reason cause reoperation. Electrocardiogram, non-invasive blood pressure, pulse oximetry, temperature,capnography, and end tidal anesthetic concentration values are monitored in patients Parental presence will be allowed if requested for the induction of anesthesia. Pediatrics without vein access will receive general anesthesia which induces with 8% sevoflurane in 70% nitrous oxide and 30% oxygen, via a facemask. When loss of consciousness is achieved,investigators need to establish vein access routinely.Intravenous induction for general anesthesia with endotracheal intubation is commenced using intravenous propofol 3 mg/kg, cis-atracurium 0.2 mg/kg,fentanyl 2. ug/kg. Anesthesia will be maintained using remifentanyl, and a volatile anesthetic(sevoflurane). The inhaled concentration of sevoflurane will be adjusted to maintain hemodynamic stability, which is defined as a change in systolic blood pressure and heart rate of no more than 20% of baseline parameters. The use of opioids during the perioperative periods at the discretion of the anesthetist. Some anesthetists administer opioids preemptively, however, in the majority of cases the decision is based on the cardiovascular response to stimulation; an increase in heart rate of 10% from baseline is usually interpreted as insufficient analgesia and is treated with opioids. Patients will be given either fentanyl in doses of 1-2mcg/kg, remifentanil as continuous infusion 0.01-0.03 mcg/ (kg.min) or a combination of these. TFPB group Patients in transversalis fascia plane block group(Group T) will receive ultrasound-guided transversalis fascia plane block using0.3% ropivacaine(0.8 ml/kg) after general anesthesia. A high-frequency probe (Sono-Site HFL50x, 15- 6 MHz, 55-mm broadband linear array) connected to an S-nerve ultrasound machine((Sonosite Inc,Bothell, WA, USA) was positioned with a transverse orientation, between iliac crest and costal margin.With the patient in a supine position, the needle is advanced from the anterior using an in-plane technique. A linear ultrasound probe is orientated transversely over the lateral abdomen between the iliac crest and the costal margin. The external oblique, internal oblique,and transversus abdominis muscles are imaged, and the more posterior transversus aponeurosis is isolated from these muscles.The reflection of the peritoneum curving away from the muscles from anterior to posterior, and the perinephric fat, which lies behind the peritoneum and deep to the transversalis fascia, are both identified. The perinephric fat is generally more prominent closer to the iliac crest. The quadratus lumborum is identified medial to the aponeurosis of the transversus abdominis. The end point is more visible if the needle is passed through the posterior''tail'' of the transversus muscle, as the transversus aponeurosis is thinner and less distinct as a separate layer. After passing through the deep surface of transversus abdominis muscle, local anesthetic is injected to separate the transversalis fascia from the transversus muscle. The correct needle position was confirmed by injection of 2 ml of normal saline solution that was spreading anterio-posteriorly between the anterior border of QLM and its fascia, in addition to a minimal anterior spread in TAP plane. After negative aspiration, 0.8 ml/Kg of ropivacaine 0.3%was injected. QLB group Patients in quadratus lumborum block group(Group Q) will receive ultrasound-guided quadratus lumborum block using 0.3% ropivacaine(0.8 ml/kg).after general anesthesia.The TFPB is performed with the patient in the lateral position using a curvilinear low-frequency ultrasound probe.This is orientated transversely at the posterior axillary line between the iliac crest and the costal margin using a 22G 100-mm needle.The needle is directed in the posterior to anterior orientation with the practitioner standing behind the patient. The triangular quadratus lumborum (QL) muscle is adherent to the apex of the transverse process of L3 vertebra.Using the Shamrock method, a new transmuscular quadrates lumborum block technique, developed by Børglum (British Journal of Anaesthesia, 2013), the needle penetrates the QL muscle with an in-plane approach from the posterior side of the ultrasound probe. The target point is the interfascial plane between the QL and the psoas major muscle just deep to the transversalis fascia, in order to lessen the risk of unintentional penetration of the peritoneal cavity contrary to the technique. The correct needle position was confirmed by injection of 2 ml of normal saline solution that was spreading antero-posteriorly between the QL and the psoas major muscle. After negative aspiration, 0.8 ml/Kg of ropivacaine 0.3%was injected. Control group Patients in the third group as control (Group C) receive no nerve block.Patients will be extubated based on clinical criteria. Patients will then be transported to the post-operative anesthesia care unit (PACU) after extubation.All pediatric patients will receive 6-hourly paracetamol post-operatively for two days and receive sufentanyl via nurse-controlled analgesia (NCA) or patient-controlled analgesia (PCA). The prescription of post-operative NCA/PCA is also at the discretion of the anesthetist. Children under the age of 6 years will receive sufentanyl via NCA continuously at a rate of 2 mcg/(kg.48h) with a bolus option of 0.01 mcg/kg every 15 minutes.Older children will receive sufentanyl via PCA continuously at a rate of 2 mcg/( kg.48h) with a bolus option of 0.01 mcg/kg every 15 minutes. Data collection will include the type of procedure, age, weight, type of truncal block (QLB group vs TFPB vs control).Primary outcome was the FLACC (ie, the Face, Legs, Activity, Consolability Scale) score of patients in the PACU and at 2h, 4h, 8h, 12h, 24h, 48h postoperatively. Secondary outcomes included intraoperative MBP and HR at the endpoints of Salter acetabular osteotomy(T1), femoral rotation osteotomy (T2), and anterior superior iliac spine osteotomy (T3) during the surgery; intraoperative opioid consumption (i.e., fentanyl and remifentanil); duration of the surgery; postoperative fentanyl consumption in the PACU, postoperative morphine consumption in the ward; the length of PACU stay; the time until first press of NCA/PCA pump and the total counts number of pressing the pump; length of hospital stay; complications (e.g., immediate complications such as vessel puncture and possible undesirable effects such as hypotension, bradycardia, epidural local anesthetic spread, or postoperative nausea and vomiting). The number of doses of rescue analgesics (morphine 0.05 mg/kg) in the postoperative period (48 h) will be recorded. Rescue treatment of postoperative nausea and vomiting,will be treated with ondansetron (0.1 mg/kg) if needed.Side effects such as pruritus will also be noted.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Developmental Dysplasia of the Hip (DDH)
Keywords
transversalis fascia plane block, quadratus lumborum block, ultrasound-guided, Developmental Dysplasia of the Hip, postoperative analgesia

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
110 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Group T
Arm Type
Experimental
Arm Description
Patients in transversalis fascia plane block group(Group T) will receive ultrasound-guided transversalis fascia plane block using0.3% ropivacaine(0.8 ml/kg) after general anesthesia
Arm Title
Group Q
Arm Type
Experimental
Arm Description
Patients in quadratus lumborum block group(Group Q) will receive ultrasound-guided quadratus lumborum block using0.3%ropivacaine(0.8 ml/kg).after general anesthesia.
Arm Title
Group C
Arm Type
No Intervention
Arm Description
Patients in the third group as control (Group C)receive no nerve block.Patients will be extubated based on clinical criteria.
Intervention Type
Procedure
Intervention Name(s)
transversalis fascia plane block
Intervention Description
With the patient in a supine position, the needle is advanced from the anterior using an in-plane technique. A linear ultrasound probe is orientated transversely over the lateral abdomen between the iliac crest and the costal margin. Local anesthetic is injected to separate the transversalis fascia from the transversus muscle. The correct needle position was confirmed by injection of 2 ml of normal saline solution that was spreading anterio-posteriorly between the anterior border of QLM and its fascia, in addition to a minimal anterior spread in TAP plane. After negative aspiration, 0.8 ml/Kg of ropivacaine 0.3%was injected.
Intervention Type
Procedure
Intervention Name(s)
quadratus lumborum block
Intervention Description
The needle is directed in the posterior to anterior orientation with the practitioner standing behind the patient. The triangular quadratus lumborum (QL) muscle is adherent to the apex of the transverse process of L3 vertebra. Using the Shamrock method, the needle penetrates the QL muscle with an in-plane approach from the posterior side of the ultrasound probe. The target point is the inter fascial plane between the QL and the psoas major muscle just deep to the transversalis fascia, in order to lessen the risk of unintentional penetration of the peritoneal cavity contrary to the technique. The correct needle position was confirmed by injection of 2 ml of normal saline solution that was spreading anterio-posteriorly between the QL and the psoas major muscle. After negative aspiration, 0.8 ml/Kg of ropivacaine 0.3%was injected.
Primary Outcome Measure Information:
Title
Change of FLACC pain scores at different time points (at rest and at movement)
Description
using age-appropriate and validated tools (ie, the Face, Legs, Activity, Consolability Scale [FLACC] which evaluates the intensity of pain, ranged from 0-10, 0 means no pain and 10 means severe pain) to evaluate the change of pain scores at different time points which indirectly reflect the analgesia effect, both at rest and at movement.
Time Frame
for the first 48 post-operative hours(at PACU, 2 hours, 4 hours, 8 hours, 12 hours, 24 hours, 48 hours after surgery),the analgesic effects of patients at different times need to be evaluated, both at rest and at movement
Secondary Outcome Measure Information:
Title
The analgesia effects
Description
The first time (hours after surgery) and the total numbers to press the analgesia pump (numbers) will be recorded.
Time Frame
for the first 48 post-operative hours
Title
the rescue analgesics
Description
The number of doses of rescue analgesics (morphine 0.05 mg/kg) will be recorded.
Time Frame
for the first 48 post-operative hours
Title
complications
Description
Postoperative nausea and vomiting (the numbers of participants with nausea and vomiting), hematoma (the number of participants with hematoma), nerve injury (the number of participants with nerve injury) will be recorded
Time Frame
for the first 48 post-operative hours
Title
Intra-operative opioid consumptions
Description
intraoperative opioid consumption ((both fentanyl and remifentanil were converted into fentanyl equivalents).
Time Frame
during the surgery, average 3 hours
Title
PACU fentanyl consumptions
Description
If a pain score was >3, the patient in the PACU would receive fentanyl (iv,1 μg·kg-1), while in the surgical ward morphine (iv,0.05 mg·kg-1) was administered.
Time Frame
the time of staying in postanesthesia care unit(PACU), about 30 minutes to 60 minutes after surgery
Title
PACU fentanyl rate
Description
the number of patients who received the fentanyl in each group during the PACU
Time Frame
the time of staying in post-anesthesia care unit(PACU), about 30 minutes to 60 minutes after surgery
Title
PACU stay
Description
staying period in the PACU
Time Frame
the time of staying in post-anesthesia care unit(PACU), about 30 minutes to 60 minutes after surgery
Title
Hospital stay
Description
staying period in the hospital
Time Frame
the time of staying in hospital, average 12 days
Title
Parental satisfaction score (0-10)
Description
Satisfaction from all patients' guardians were surveyed with regard to the postoperative analgesia of their children at the time of the NCA/PCA pump removal
Time Frame
at 48 post-operative hours, when removed the NCA/PCA pump

10. Eligibility

Sex
All
Minimum Age & Unit of Time
2 Years
Maximum Age & Unit of Time
10 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Pediatric patients aged between 2 years and 10 years with DDH, scheduled for unilateral open reduction surgeries(Salter acetabular osteotomy,combined with proximal femoral rotation osteotomy) Exclusion Criteria: Patients will be excluded if they meet any of the following criteria: patients with known allergy to local anaesthetics, mental disability, peripheral neuropathy, a coagulopathy disorder, localized infection in the area, any reason cause reoperation.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
CongCong Huang, Master
Organizational Affiliation
Second Affiliated Hospital of Wenzhou Medical University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Beijing Jishuitan Hospital
City
BeiJing
State/Province
Beijing
ZIP/Postal Code
100000
Country
China
Facility Name
Second Affiliated Hospital of WenZhou Medical University
City
Wenzhou
State/Province
Zhejiang
ZIP/Postal Code
325000
Country
China

12. IPD Sharing Statement

Plan to Share IPD
No
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Links:
URL
http://bja.oxfordjournals.org/forum/topic/brjana_el%3b9919
Description
Ultrasound-guided transmuscular quadratus lumborum blockade.

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Truncal Blocks for Pediatric With Developmental Dysplasia of the Hip Undergoing Open Reduction

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