Objective
To evaluate the analgesic effectiveness of two novel regional nerve
blocks in paediatric patients with developmental dysplasia of the hip
(DDH) after open reduction surgeries.
Design
Prospective, double-blinded, randomised controlled trial.
Setting
2 tertiary teaching hospitals in China between August 2017 and July
2018.
Participants
110 paediatric patients aged 2–10 years with DDH undergoing open
reduction surgeries were recruited, 95 were randomised and 90 were
included in the final analysis.
Interventions
Random assignment to quadratus lumborum block III (QLB III) group,
transversalis fascia plane block (TFPB) group and the control (no region
nerve block) group.
Primary and secondary outcome measures
The primary outcome was the Face, Legs, Activity, Cry and
Consolability (FLACC) Scale Scores. Secondary outcomes included
perioperative opioid consumption, the time until first press of
nurse-controlled analgesia/patient-controlled analgesia (NCA/PCA) pump
and the total counts number of pressing, length of postanaesthesia care
unit (PACU) stay, length of hospital stay, parental satisfaction with
pain management and adverse events.
Results
Mean FLACC Scores were significantly lower in QLB III group and TFPB
group while in the PACU and for 48 hours postoperatively, compared with
control group (p<0.0001, p<0.0001, respectively). No differences
were found for FLACC Scores between QLB III group and TFPB group,
neither at rest (p=0.0402) nor while posture changing (p=0.0306). TFPB
prolonged the first-time request for NCA/PCA analgesia, and decreased
the total number of pressing counts, compared with QLB III (22.5 (16.2
to 28.7) vs 11.7 (6.6 to 16.8), p<0.0001; 2.4 (1.3 to 3.6) vs 3.8
(2.8 to 4.8), p=0.0111, respectively). No patient experienced any
adverse events.
Conclusions
We suggested that both ultrasound-guided QLB III and TFPB should be
considered as an option for perioperative analgesia in children with DDH
undergoing open reduction surgeries. TFPB was superior to the QLB III
because it prolonged the first-time request for NCA/PCA analgesia and
decreased the total counts number of pressing.
Trial registration number
NCT03189966/2017.
Background. General anesthesia combining with a caudal block (CB) has been commonly performed in pediatric patients undergoing circumcision surgeries. However, some severe complications have been suspected of a caudal block in the combined use. To avoid these issues of a caudal block, this study introduces a novel dorsal penile nerve block (DPNB) via perineum guided by ultrasound as an alternative to a caudal block in pediatric circumcision surgeries. Methods. A total of 104 pediatric patients scheduled for circumcision surgeries were involved and randomly divided into 2 groups: the CB group (n=52) and the DPNB group (n=52). A laryngeal mask was inserted followed by induction and maintenance anesthesia of inhaled sevoflurane. In the DPNB group, a dorsal penile nerve block (DPNB) guided by a real-time ultrasonography was performed by a single injection via perineum of 0.25% ropivacaine plus 0.8% lidocaine with total injection volume of 3-5ml. In the CB group, a dose of 0.5 ml/kg was given via the caudal canal following the same general anesthesia with that of Group DPNB. The time to the first analgesic demand after surgery is the key data collected for comparing between the two study groups. Heart rates and respiratory rates changes before and during the surgical procedure, pain score when leaving the PACU, and the time taken for the first micturition after a surgery were also recorded to analyze the differences in analgesic effects between the CB and DPNB groups. Results. No significant difference in heart rates and respiratory rates was found between the two groups before and during the surgery. Pain scores were similar before pediatric patients leave the PACU. However, the time taken for the first micturition after a surgery in Group DPNB is shorter than Group CB. The patients in Group DPNB asked for analgesics later than those in Group CB. Additionally, no significant differences in adverse effects were noted between two groups except the numbness of the lower limbs occurring less in Group DPNB. Conclusions. The ultrasound-guided dorsal penile nerve block via perineal approach can basically act as a safe and effective alternative to the caudal block in pediatric patients undergoing circumcision surgeries. Clinical Trials identifier is ChiCTR-IPR-15006670. Protocol is available at http://www.chictr.org.cn/showproj.aspx?proj=11319.
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