Could Peri-anal Block be Effective as Caudal Block in Trans-anal Pull-through Surgery ??.

NCT ID: NCT04367818

Last Updated: 2021-08-23

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

60 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-06-30

Study Completion Date

2022-08-01

Brief Summary

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IN pediatric patient population pain is considered one of the most misunderstood; under diagnosed and under treated medical problems. If left uncontrolled, pain may have a diverse effect on all aspects of life as it is only a sensory perception but also has emotional, cognitive and behavioral components.

Detailed Description

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Caudal anesthesia is one of the most commonly used regional anesthetic and analgesic technique in pediatric patient as it is an easy safe and reliable method that can be performed for both intraoperative and postoperative analgesia in patient undergoing lower abdominal and lower limb surgery. It can be used for upper abdominal surgery by increasing the volume of local anesthetic injected or through advancing a catheter.

Caudal anesthesia is a common practice given along with general anesthesia to decrease intraoperative inhalational anesthesia requirements, postoperative pain and emergence agitation.

So many patients are complaining from ano-rectal pathologies, these diseases are common in both sexes and all age groups. The spectrum of anorectal disorders ranges from benign and irritating (pruritus- ani) to potentially life-threatening (anorectal cancer) and the surgical intervention is performed mostly under general or regional anesthesia.

While general and regional anesthetics provide reliable anesthesia, they are often associated with nausea,vomiting, urinary retention and motor blockade of lower limbs. Moreover, repeated spinal or epidural punctures performed by inexperienced anesthesiologists often cause delays in the tight schedule of operations.

Several reports have described various forms of local anesthetic infiltration for ano- rectal surgery , hemorrhoidectomy,anal fistula or fissure surgeries or lateral sphincterotomy. Local peri-anal infiltration is a simple procedure that can be easily learned and performed by surgeon and this method allows the operation to begin almost immediately.

There are different types of local anesthesia like infiltration, nerve block, ring block field block. Considering anorectal surgeries, nerve bock mainly pudendal nerve along with infiltration anesthesia is used worldwide. Perianal block by local anesthetic infiltration is safe simple and effective for various anal operations with very high degree of acceptance and satisfaction among patients .it had been found to be associated with low pain score and postoperative complications and faster return to daily social activity.

Although there are studies on the use of caudal block and local infiltration of anesthetic agent for the surgical resolution of anorectal pathologies, there is no established protocol for comparing efficacy, postoperative pain, and satisfaction among pediatrics patient undergoing trans-anal pull through in congenital megacolon (Hirschsprung's disease).

Conditions

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Analgesia

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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Peri-anal local anaesthetic infiltration

Patients in this group will receive the prepared anesthetic mixture (bupivacaine 0.25% in dose of 1ml\\kg plus dexametomidine 2ug\\kg diluted in 0.5ml of normal saline) in a syringe will be connected to 22\_ gauge short, beveled needle. The technique of the block will be done guided by Nystrom et al.

Group Type ACTIVE_COMPARATOR

Peri-anal local anaesthetic infiltration

Intervention Type PROCEDURE

postoperative pain relieve, among pediatrics patient

caudal anaesthesia

Patients in this group will receive caudal block using 22\_gauge short, beveled cannula or needle, The prepared anesthetic mixture (bupivacaine 0.25% in dose of 1ml\\kg plus dexametomidine 2ug\\kg diluted in 0.5ml of normal saline).

Group Type ACTIVE_COMPARATOR

Caudal anaesthesia

Intervention Type PROCEDURE

Regional anaesthesia for postoperative pain relieve, among pediatrics patient

Interventions

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Peri-anal local anaesthetic infiltration

postoperative pain relieve, among pediatrics patient

Intervention Type PROCEDURE

Caudal anaesthesia

Regional anaesthesia for postoperative pain relieve, among pediatrics patient

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Patients of both sexes.
* Patients with age range 3 to 10 years old.
* Patients with ASA 1 , 2 classification.

Exclusion Criteria

* Patient or parents refusal.
* Allergy to the study drugs.
* Suspect coagulopathy.
* Local infection at site of intervention.
* History of developmental delay.
* Neuromuscular disorders.
* Skeletal deformity.
Minimum Eligible Age

3 Years

Maximum Eligible Age

10 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Assiut University

OTHER

Sponsor Role lead

Responsible Party

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Mohamed Salah Rashed Abd Elraheem

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Mohamed Salah Rashed

Asyut, , Egypt

Site Status RECRUITING

Countries

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Egypt

Central Contacts

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Esam Abdalla, Professor

Role: CONTACT

01009633737

Fatma Nabil, Professor

Role: CONTACT

01003633992

Facility Contacts

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Mohamed Salah Rashed, Resident

Role: primary

01002360078

Esam Eldin Abdalla, professor

Role: backup

01009633737

References

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de Beer DA, Thomas ML. Caudal additives in children--solutions or problems? Br J Anaesth. 2003 Apr;90(4):487-98. doi: 10.1093/bja/aeg064. No abstract available.

Reference Type BACKGROUND
PMID: 12644422 (View on PubMed)

Gopal DV. Diseases of the rectum and anus: a clinical approach to common disorders. Clin Cornerstone. 2002;4(4):34-48. doi: 10.1016/s1098-3597(02)90004-9.

Reference Type BACKGROUND
PMID: 12739325 (View on PubMed)

Gabrielli F, Cioffi U, Chiarelli M, Guttadauro A, De Simone M. Hemorrhoidectomy with posterior perineal block: experience with 400 cases. Dis Colon Rectum. 2000 Jun;43(6):809-12. doi: 10.1007/BF02238019.

Reference Type BACKGROUND
PMID: 10859082 (View on PubMed)

Luck AJ, Hewett PJ. Ischiorectal fossa block decreases posthemorrhoidectomy pain: randomized, prospective, double-blind clinical trial. Dis Colon Rectum. 2000 Feb;43(2):142-5. doi: 10.1007/BF02236970.

Reference Type BACKGROUND
PMID: 10696885 (View on PubMed)

Nystrom PO, Derwinger K, Gerjy R. Local perianal block for anal surgery. Tech Coloproctol. 2004 Mar;8(1):23-6. doi: 10.1007/s10151-004-0046-8.

Reference Type BACKGROUND
PMID: 15057585 (View on PubMed)

Kaban OG, Yazicioglu D, Akkaya T, Sayin MM, Seker D, Gumus H. Spinal anaesthesia with hyperbaric prilocaine in day-case perianal surgery: randomised controlled trial. ScientificWorldJournal. 2014;2014:608372. doi: 10.1155/2014/608372. Epub 2014 Oct 14.

Reference Type BACKGROUND
PMID: 25379541 (View on PubMed)

Zhang Y, Bao Y, Li L, Shi D. The effect of different doses of chloroprocaine on saddle anesthesia in perianal surgery. Acta Cir Bras. 2014 Jan;29(1):66-70. doi: 10.1590/S0102-86502014000100010.

Reference Type BACKGROUND
PMID: 24474180 (View on PubMed)

Anannamcharoen S, Cheeranont P, Boonya-usadon C. Local perianal nerve block versus spinal block for closed hemorrhoidectomy: a ramdomized controlled trial. J Med Assoc Thai. 2008 Dec;91(12):1862-6.

Reference Type BACKGROUND
PMID: 19133521 (View on PubMed)

Other Identifiers

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CPABBEACB

Identifier Type: -

Identifier Source: org_study_id

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