Ultrasound Guided Rectus Sheath Block in Pediatric Single Port Laparoscopic Appendectomy
Study Details
Study Description
Brief Summary
The current study aimed to assess the analgesic effect of ultrasound guided RSB with dexmedetomidine in the perioperative period of the surgical site after appendectomy In comparing only the postoperative outcome
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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N/A |
Detailed Description
laparoscopic appendectomy is one of the most frequently performed pediatric surgeries. Although minimally invasive, this technique is still associated with a significant amount of pain and anxiety in children . Indeed, children who are highly anxious prior to surgery tend to have more postoperative pain, delayed hospital discharge, and higher incidence of emergence delirium, sleep disturbances, and other mal-adaptive behavior changes that can last up to a few weeks following surgery . To improve analgesia and decrease postoperative anxiety in children undergoing laparoscopic appendectomies multimodal approach for pain control can be employee; Over the past years, the concept of pain management has extended from simply decreasing pain intensity to optimizing patient's condition. The goal is to decrease pain scores, stress response that should be avoided in patients, particularly cardiac patients, together with a decrease in analgesics-related adverse effects like nausea, vomiting, retention of urine and over sedation. By achieving these goals, we can certainly facilitate patient recovery and minimize the hospital stay. Improved pain control can be achieved by a combination of different types of regional analgesia with systemic analgesics. The main contributor to pain post abdominal operations is the pain from abdominal wall incision .
Many procedures were followed to decrease this intense postoperative pain such as, epidural catheter analgesia, Transverse Abdominis Plane (TAP) block, local wound infiltration, Patient-Controlled Analgesia (PCA), peripheral nerve blocks, in addition to Systemic administration of Non-Steroidal Anti- Inflammatory Drugs (NSAIDs) or opioids.
The Rectus Sheath Block (RSB) is one of these regional techniques that are suitable for operations with a midline incision or laparoscopic surgery with the main incision at the umbilical port. A previous study showed the analgesic efficacy of ultrasound guided rectus sheath block for laparoscopic appendectomy compared to a control group injected with saline instead of a local anesthetic in addition to the usefulness of traditional local anesthetics to provide analgesia during the course of the postoperative period is restricted by their short duration of action. Dexmedetomidine (DEX) has been shown as a valuable additive to local anesthetics in neuraxial blocks and peripheral nerve blocks leading to prolongation of postoperative analgesia and better pain control .
. dexmedetomidine (DEX) α-2 adrenergic receptor consists of three α-2 isoacceptors (α-2a, α-2b and α-2c), which regulate the various pharmacodynamic effects of this drug . The α-2a receptor seems to promote sedation and anxiolysis in the locus coeruleus, as well as to generate bradycardia and peripheral vasodilation by stimulation of the cerebral vasomotor center. The α-2b receptor prevents tremor, generates analgesia in the dorsal horns of the spinal cord and determines peripheral vasoconstriction. The α-2c receptor modulates the mental stat.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Placebo Comparator: group Bupivacaine will include 30 patients: each one will receive 2.5 mg/kg of 0.25% bupivacaine diluted in a 20 mL syringe of normal saline , 10 minutes before skin incision |
Procedure: Ultrasound guided rectus sheath block
Sixty patients were randomized to receive ultrasound-guided RSB After the induction of anesthesia and patient stabilization, the abdomen was sterilized and draped. Then, under complete aseptic conditions, ultrasound-guided Bilateral Rectus Sheath Block (BRSB) was performed
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| Active Comparator: group bupivacaine&dex 2 will include 30 patients: each one will receive 2.5mg/kg of 0.25% bupivacaine plus 2 µ/kg of dexmedetomidine diluted in a 20 mL syringe of normal saline , 10 minutes before skin incision |
Procedure: Ultrasound guided rectus sheath block
Sixty patients were randomized to receive ultrasound-guided RSB After the induction of anesthesia and patient stabilization, the abdomen was sterilized and draped. Then, under complete aseptic conditions, ultrasound-guided Bilateral Rectus Sheath Block (BRSB) was performed
|
Outcome Measures
Primary Outcome Measures
- evaluate the first call for rescue analgesia [24 hours after recovery from anesthesia]
the time of the first call for analgesia is recorded
Eligibility Criteria
Criteria
Inclusion Criteria:
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● Age: 3-8years.
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Weight: 10-60 kg.
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Sex: both males and females.
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ASA physical status: I-II.
Exclusion Criteria:
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• Patient's guardian refusal to participate in the study.
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Patients having known hypersensitivity to dexametomidine will be excluded.
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Patients with cardiovascular, liver or renal disease, unsatisfactory preoperative peripheral arterial oxygen saturation, neurological or psychiatric disease and coagulation disturbances.
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Any perioperative cardiovascular or respiratory event occurred or difficulties in pain perception and assessment which make the study intervention clinically unacceptable.
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Patients on regular use of analgesic or who received analgesic 24 h before surgery
Contacts and Locations
Locations
No locations specified.Sponsors and Collaborators
- Assiut University
Investigators
None specified.Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 01210861577