Efficacy and Safety of Quadratus Lumborum Block Versus Pericapsular Nerve Group Block in Pediatric Hip Surgery (TQL)
Pain, Postoperative, Developmental Dislocation of Hip
About this trial
This is an interventional prevention trial for Pain, Postoperative focused on measuring quadratus lumborum block, pericapsular nerve group block, developmental dysplasia of the hip, postoperative analgesia, pediatric, hip surgery
Eligibility Criteria
Inclusion Criteria:
- American society association (ASA) physical status class I - II.
- Participants who will be scheduled for an elective unilateral open hip surgery for correction of DDH under general anesthesia
Exclusion Criteria:
- Participants with respiratory disease, renal or hepatic insufficiency.
- Infection of the skin in the puncture area.
- Coagulopathy.
- Allergy against any of the drugs to be used (bupivacaine).
- Neuromuscular disease.
- Obesity (body mass index, BMI >30).
- Previous hip surgery.
- Previous analgesic medication, chronic pain.
- Previously known neurological pathologies or central nervous system disorders
Sites / Locations
- Alexandria University
Arms of the Study
Arm 1
Arm 2
Experimental
Experimental
trans muscular quadratus lumborum (TQL) block
Pericapsular nerve group (PENG) block
after induction of general anesthesia (GA), the participant will be placed in the lateral position, and a high-frequency linear ultrasound probe (5-13 MHz) will be placed on the anterior iliac crest. The Petit's triangle (formed of the iliac crest inferiorly and the borders of external abdominal oblique anteriorly and latissimus dorsi (LD) posteriorly) will be identified and then Tracing dorsally from Petit's triangle, the external oblique, and the internal oblique are seen disappearing into an aponeurosis as the quadratus lumborum (QL) appears beneath the LD (anteriorly), and going farther dorsally, the QL, erector spinae, and psoas major (PM) muscles around the transverse process of lumbar vertebra L4 are seen. A 22-gauge needle will be inserted using an in-plane technique along the posterior edge of the probe in the anteromedial direction. The needle tip will be placed between the QL muscle and the PM muscle, then 0.5 ml/kg of 0.25% bupivacaine will be injected.
After induction of GA, the participant will be in the supine position. A linear high-frequency ultrasound probe (5-13MHz) will be initially placed in a transverse plane over the anterior inferior iliac spine (AIIS) and then aligned with the pubic ramus by rotating the probe counterclockwise approximately 45 degrees; In this view, the ilio-pubic eminence (IPE), the iliopsoas muscle and tendon, the femoral artery, and pectineus muscle will be observed. A 22-gauge, 80-mm needle Will be inserted from lateral to medial in an in-plane approach to place the tip in the musculofascial plane between the psoas tendon anteriorly and the pubic ramus posteriorly. Following negative aspiration, the local anesthetic solution of 0.25% bupivacaine will be injected in 5-mL increments while observing for an adequate fluid spread in this plane for a total volume of 0.5 ml/kg.