| INTERVENTIONS |
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Intervention type
|
Intervention name
|
Dose
|
Duration
|
Intervention description
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Group size
|
Nature of control
|
| Experimental Group |
Erector spinae plane block group |
0.5 ml/kg of 0.25% isobaric bupivacaine (max 20 ml) |
once after induction of anesthesia |
after Patient fasting for 6 hours, and giving premedications, and pre-oxygenation with 100% oxygen for at least 3 minutes, Induction of anesthesia will be performed by fentanyl 1 mcg/kg, Propofol 2 mg/kg followed by cis-atracurium 0.15 mg/kg. Then, patients will be manually ventilated with 100% oxygen till intubation after 2 min. Maintenance of anesthesia will be carried out by isoflurane and cis-atracurium 0.03 mg/kg guided by neuromuscular monitor. After induction of general anesthesia, US-guided ESPB block will be commenced as follows: The patient will be placed in the lateral position and a high-frequency linear ultrasound transducer will be placed in a longitudinal orientation 1 cm lateral to the thoracic tenth spinous process. The deep plane to the erector spinae muscle will be identified. 0.5 ml/kg of 0.25% isobaric bupivacaine (max 20 ml) will be injected into the interfacial plane between rhomboid major and erector spinae muscles. Hemodynamics will be maintained within 25 % of baseline. Tramadol 0.5 mg/kg will be given intravenously as a rescue analgesic if heart rate or blood pressure increased more than 10% of baseline. Upon completion of wound closure, isoflurane will be discontinued and residual neuromuscular block will be reversed with neostigmine, 0.05 mg/kg IV, and atropine 0.25 mg/kg, IV. The trachea will be extubated when the patient is fully awake. The patients will be kept in PACU unit for close monitoring for 4 hours after recovery. IV paracetamol 15 mg/kg will be given postoperatively if the facial pain scores ≥ 4. The patients were discharged home on a protocol of paracetamol 15 mg/kg oral syrup to be repeated every 6 hours for 48 hours; no postoperative opioids were prescribed for use at home. if pain score still ≥4 after 30 minutes of paracetamol dose, oral ibuprofen 5mg/kg will be given, After patients discharge, contact with the mothers will be done to know the time of the first request of analgesia if wasn’t during hours of hospital stay. |
47 |
|
| Experimental Group |
Caudal block group |
1 ml/kg of 0.25% isobaric bupivacaine(Max 20 ml) |
once after induction of anesthesia |
after Patient fasting for 6 hours, and giving premedications, and pre-oxygenation with 100% oxygen for at least 3 minutes, Induction of anesthesia will be performed by fentanyl 1 mcg/kg, Propofol 2 mg/kg followed by cis-atracurium 0.15 mg/kg. Then, patients will be manually ventilated with 100% oxygen till intubation after 2 min. Maintenance of anesthesia will be carried out by isoflurane and cis-atracurium 0.03 mg/kg guided neuromuscular monitor. After induction of general anesthesia, the caudal block will be commenced as follows: The child will be placed in the left lateral decubitus position. After insertion of a 23-gauge needle into caudal epidural space under the guidance of ultrasound and negative aspiration for blood and cerebrospinal fluid, 1 ml/kg of 0.25% isobaric bupivacaine(Max 20 ml), will be injected.Hemodynamics (blood pressure and heart rate) will be maintained within 25 % of baseline measures. Tramadol 0.5 mg/kg will be given intravenously as a rescue analgesic if heart rate or blood pressure increased more than 10% of baseline. Upon completion of wound closure, isoflurane will be discontinued and the residual neuromuscular block will be reversed with neostigmine, 0.05 mg/kg IV, and atropine 0.25 mg/kg, IV. The trachea will be extubated when the patient is fully awake. The patients will be kept in PACU unit for close monitoring for 4 hours after recovery. IV paracetamol 15 mg/kg will be given postoperatively if the facial pain scores ≥ 4. The patients were discharged home on a protocol of paracetamol 15 mg/kg oral syrup to be repeated every 6 hours for 48 hours; no postoperative opioids were prescribed for use at home. if pain scores still ≥4 after 30 minutes of paracetamol dose, oral ibuprofen 5mg/kg will be given, After patients discharge, contact with the mothers will be done to know the time of the first request of analgesia if wasn’t during hours of hospital stay.
|
47 |
|
| Control Group |
control group |
regular systemic analgesics |
intraoperative and postoperative |
after Patient fasting for 6 hours, and giving premedications, and pre-oxygenation with 100% oxygen for at least 3 minutes, Induction of anesthesia will be performed by fentanyl 1 mcg/kg, Propofol 2 mg/kg followed by cis-atracurium 0.15 mg/kg.Then, patients will be manually ventilated with 100% oxygen till intubation after 2 min. Maintenance of anesthesia will be carried out by isoflurane and cis-atracurium 0.03 mg/kg guided neuromuscular monitor. No regional anesthesia will be performed. Hemodynamics (blood pressure and heart rate) will be maintained within 25 % of baseline measures. Tramadol 0.5 mg/kg will be given intravenously as a rescue analgesic if heart rate or blood pressure increased more than 10% of baseline.Upon completion of wound closure, isoflurane will be discontinued and residual neuromuscular block will be reversed with neostigmine, 0.05 mg/kg IV, and atropine 0.25 mg/kg, IV. The trachea will be extubated when the patient is fully awake. The patients will be kept in the PACU unit for close monitoring for 4 hours after recovery. IV paracetamol 15 mg/kg will be given postoperatively if the facial pain scores ≥ 4. The patients were discharged home on a protocol of paracetamol 15 mg/kg oral syrup to be repeated every 6 hours for 48 hours; no postoperative opioids were prescribed for use at home. if pain scores still ≥4 after 30 minutes of paracetamol dose, oral ibuprofen 5mg/kg will be given , After patients discharge, contact with the mothers will be done to know the time of the first request of analgesia if wasn’t during hours of hospital stay.
|
47 |
Active-Treatment of Control Group |