Analgesic Efficacy of Bilateral US Guided TTPB vs ESPB in Pediatric Patients Undergoing Corrective Cardiac Surgeries

Summary

Corrective cardiac surgeries include a bundle of major surgeries that take place in pediatric patients and require imperative perioperative pain control; hence, the art of healing starts from trying to diminish or abolish pain.

The use of highly potent opioids for paediatric cardiac anaesthesia has gained widespread popularity during the last 20 years . In addition to the important advantage of hemodynamic stability, the large-dose opioid-based anaesthetic techniques also blunt the stress response; however, large doses can cause over sedation, respiratory depression and prolonged mechanical ventilation after surgery .

There are many ways to limit pain in such population with the topper potent opioids in the last several years. But new regional pain management modalities started to arise because of their known effect to diminish neuroendocrine stress response, provide excellent postoperative analgesia, and facilitate early postoperative extubation .

Of the new evolving methods, the bilateral Transversus Thoracic Muscle Plane Block (TTPB) provides analgesia to the anterior chest wall and proved to be efficient in pediatric patients undergoing cardiac surgery using a median sternotomy approach .

The bilateral Erector Spinae Plane Block (ESPB) is also one of the recently known pain controlling techniques used in pediatric cardiac surgeries. It became popular because it is much safer and easily administered than other alternative regional techniques as thoracic paravertebral and thoracic epidural block .

Conditions

• Pain, Postoperative

Interventions

PROCEDURE

Erector spinae plane block

Under strict aseptic precautions, The T3 spinous process will be located. A high-frequency 12 MHz linear US transducer will be placed in a longitudinal orientation 3 cm lateral to the T3 spinous process corresponding to the T2 transverse process. Three muscles; trapezius (uppermost), rhomboids major (middle), and erector spinae (lowermost) will be identified superior to the hyperechoic transverse process. Using in-plane approach a 25 G needle will be inserted in caudal-cephalad direction, until the tip is deep to erector spinae muscle. Correct needle tip location will be confirmed by injecting 3 mL of normal saline and visualizing the linear LA spread (i.e., hydrodissection) in the fascial plane between the erector spinae muscle and the transverse process. Then, 0.4 ml/kg (1:1 solution of bupivacaine 0.25% and lidocaine 1%) will be injected and visualizing the linear LA spread in the fascial plane between the erector spinae muscle and the transverse process.

PROCEDURE

Transversus thoracis plane block

Under strict aseptic precautions, the T4-T5 intercostal space is identified under US using the US probe in the longitudinal plane 1 cm lateral to the sternal border. A high-frequency linear transducer is used. Next, a parasternal sagittal view of the intercostal muscle and the transverses thoracis muscle between the 4th and 5th rib is visualized above the pleura and a 22G, 5-10 cm needle is inserted in-plane (according to patient's body habitus and relevant anatomy) to the transducer with bevel up until the tip of the needle is located in the transverses thoracis muscles. After excluding intravascular and intrapleural placement, local anesthetic is adminstred bilaterally by injecting 0.4ml/kg (1:1 solution of bupivacaine 0.25% and lidocaine 1%) at each side.

Sponsors & Collaborators

• Cairo University

  lead OTHER

Principal Investigators

• Amel H Abo Elela, Professor · Cairo University

• Mohamed F Youssef, Professor · Cairo University

• Mai A Madkour, Professor · Cairo University

• Ahmed A Gado, Lecturer · Cairo University

Study Design

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

SINGLE

Model

FACTORIAL

Eligibility

Min Age

6 Months

Max Age

4 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2022-11-01

Primary Completion

2023-09-14

Completion

2023-09-14

Countries

• Egypt

Study Locations