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Inguinal HerniaNCT07916233

Lumbar ESP Block Versus TAP Block for Postoperative Pain Control in Children Undergoing Open Inguinal Hernia Repair

A study testing Ultrasound-guided Lumbar Erector Spinae Plane Block (ESPB) and Ultrasound-guided Transversus Abdominis Plane (TAP) Block in people with Inguinal Hernia and Postoperative Pain, run by Beni-Suef University at 1 site in Egypt.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
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Trial summary

This study evaluates two ultrasound-guided nerve block techniques-Erector Spinae Plane Block (ESPB) and Transversus Abdominis Plane (TAP) block-for pain relief in children undergoing elective open inguinal hernia repair. Read more about this study

Who is it for?
Ages 2 to 8 years
Conditions the study is for
Inguinal Hernia, Postoperative Pain
What is being tested?
Ultrasound-guided Lumbar Erector Spinae Plane Block (ESPB) and Ultrasound-guided Transversus Abdominis Plane (TAP) Block
Could I receive a placebo?
No, everyone receives an active treatment
How many people
90 participants
Where
1 siteEgypt
Study dates
Nov 2026to May 2027
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 2 to 8 years
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • Children aged 2 to 8 years at the time of enrollment.
  • American Society of Anesthesiologists (ASA) physical status I or II.
  • Scheduled for elective unilateral open inguinal hernia repair as day-case or short-stay surgery.
  • Body weight between 10 kg and 35 kg (to ensure local anesthetic dosing remains within predefined safe exposure limits).
  • Written informed consent provided by parents or legal guardians, and age-appropriate assent from children where developmentally feasible.

Who cannot join

  • Refusal of trial participation by parents or legal guardians.
  • Known allergy, hypersensitivity, or contraindication to amide local anesthetics, paracetamol, or ibuprofen.
  • Coagulopathy, bleeding disorder, or current anticoagulant/antiplatelet therapy.
  • Active localized infection at or near either planned injection site (paraspinal or lateral abdominal wall).
  • Pre-existing neurological, neuromuscular, or spinal disease affecting the lower limbs or trunk.
  • Significant hepatic, renal, or cardiac dysfunction.
Show all 9Show fewer
  • Severe cerebral palsy, developmental delay, or neurobehavioral disorders resulting in abnormal baseline tone or movement that would render behavioral pain scoring (FLACC) unreliable.
  • Bilateral inguinal hernia repair (due to bilateral block considerations).
  • Previous participation in this clinical trial.

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Kerollos Moneer Neseem Mikhael, MD contact

00201288549959

Kmnmk87@med.bsu.edu.eg

Egypt1 site
  • Beni-Suef University Hospital

    Banī Suwayf

Other trials in Egypt

About this study

Official title: Ultrasound-Guided Lumbar Erector Spinae Plane Block Versus Transversus Abdominis Plane Block for Postoperative Analgesia in Children Undergoing Open Inguinal Hernia Repair: A Randomized Double-Blind Controlled Trial

This study evaluates two ultrasound-guided nerve block techniques-Erector Spinae Plane Block (ESPB) and Transversus Abdominis Plane (TAP) block-for pain relief in children undergoing elective open inguinal hernia repair.

Children aged 2 to 8 years scheduled for unilateral open inguinal hernia surgery under general anesthesia will be randomly assigned to receive either a lumbar ESP block or a TAP block before surgery begins. Both groups will receive standardized pain management with non-opioid pain relievers (paracetamol and ibuprofen).

The main goal of the study is to compare how long each nerve block provides effective pain relief before the child requires additional pain medication (rescue opioid) within the first 24 hours after surgery. The study will also assess overall pain scores, total opioid consumption, postoperative recovery, and safety.

Read the detailed description

Effective postoperative analgesia is essential in pediatric open inguinal hernia repair to attenuate the surgical stress response, facilitate early ambulation, and enable same-day discharge. While caudal epidural block has traditionally served as the standard regional technique in pediatric lower abdominal surgery, concerns regarding motor block, urinary retention, and rare neuraxial complications have driven interest toward peripheral ultrasound-guided fascial plane blocks.

Ultrasound-guided Transversus Abdominis Plane (TAP) block provides somatic analgesia to the anterolateral abdominal wall by targeting the anterior rami of lower thoracolumbar spinal nerves (T10-L1). Recent meta-analyses demonstrate that TAP block prolongs analgesia duration and reduces rescue opioid requirements compared to caudal blockade.

Ultrasound-guided Lumbar Erector Spinae Plane Block (ESPB) is an interfascial plane technique where local anesthetic deposited deep to the erector spinae muscle at the L1 transverse process produces craniocaudal spread, blocking dorsal and ventral rami. Recent trials suggest lumbar ESPB provides effective somatic analgesia, but the degree of visceral inguinal coverage via genitofemoral and ilioinguinal pathways remains debated.

Direct, prospective head-to-head comparisons between ultrasound-guided lumbar ESPB and TAP block in pediatric open inguinal hernia repair remain limited-particularly studies utilizing a double-blind methodology, standardized multimodal analgesia, and identical local anesthetic dosing.

This prospective, randomized, double-blind controlled trial aims to compare the duration and quality of postoperative analgesia provided by ultrasound-guided lumbar ESPB versus TAP block using bupivacaine 0.25% (0.5 mL/kg, maximum 20 mL) in children aged 2-8 years undergoing elective unilateral open inguinal hernia repair under general anesthesia. The primary hypothesis is that lumbar ESPB is non-inferior to TAP block with respect to time to first rescue analgesia within 24 hours postoperatively.

Being tested
Ultrasound-guided Lumbar Erector Spinae Plane Block (ESPB), Ultrasound-guided Transversus Abdominis Plane (TAP) Block
Keywords
Erector Spinae Plane Block, Transversus Abdominis Plane Block, Regional Anesthesia, Pediatric Anesthesia, Ultrasonography, Interventional, Bupivacaine, Herniorrhaphy, Acute Pain Management
Medical subject headings
Hernia, Inguinal, Pain, Postoperative

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Ultrasound-guided Lumbar Erector Spinae Plane Block (ESPB)Procedure or surgery

    Also called L-ESPB

    Single-shot ultrasound-guided lumbar ESP block performed at the L1 transverse process level using bupivacaine 0.25% at 0.5 mL/kg (maximum 20 mL, total dose 1.25 mg/kg) deposited deep to the erector spinae muscle. Administered after general anesthesia induction and before surgical incision. Standardized multimodal background analgesia (IV paracetamol 15 mg/kg q6h ± oral/IV ibuprofen 10 mg/kg q8h) is co-administered postoperatively.

  • Ultrasound-guided Transversus Abdominis Plane (TAP) BlockProcedure or surgery

    Also called TAP block

    Single-shot ultrasound-guided TAP block performed between the internal oblique and transversus abdominis muscles at the mid-axillary line using bupivacaine 0.25% at 0.5 mL/kg (maximum 20 mL, total dose 1.25 mg/kg). Administered after general anesthesia induction and before surgical incision. Standardized multimodal background analgesia (IV paracetamol 15 mg/kg q6h ± oral/IV ibuprofen 10 mg/kg q8h) is co-administered postoperatively.

Study groups in NCT07916233
Study groupRoleWhat they receive
Group E: Lumbar Erector Spinae Plane Block (ESPB)ExperimentalChildren in Group E receive an ultrasound-guided lumbar erector spinae plane block (ESPB) performed in the lateral decubitus position prior to surgical incision following general anesthesia induction. A 22-gauge 50-mm echogenic needle is advanced in-plane to contact the L1 transverse process deep to the erector spinae muscle. After negative aspiration and hydrodissection verification with 1-2 mL saline, bupivacaine 0.25% at a volume of 0.5 mL/kg (maximum 20 mL; total dose 1.25 mg/kg) is injected incrementally. Identical sterile dressings are applied over both the paraspinal and abdominal block sites to maintain blinding.
Receives: Procedure: Ultrasound-guided Lumbar Erector Spinae Plane Block (ESPB)
Group T: Transversus Abdominis Plane (TAP) BlockActive comparatorChildren in Group T receive an ultrasound-guided transversus abdominis plane (TAP) block performed in the supine position prior to surgical incision following general anesthesia induction. A 22-gauge 50-mm echogenic needle is advanced in-plane into the fascial plane between the internal oblique and transversus abdominis muscles at the mid-axillary line. After negative aspiration and hydrodissection verification with 1-2 mL saline, bupivacaine 0.25% at a volume of 0.5 mL/kg (maximum 20 mL; total dose 1.25 mg/kg) is injected incrementally. Identical sterile dressings are applied over both the paraspinal and abdominal block sites to maintain blinding.
Receives: Procedure: Ultrasound-guided Transversus Abdominis Plane (TAP) Block

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Time to First Postoperative Rescue Analgesia Request

    Measured as the duration (in hours) from the end of general anesthesia (tracheal extubation) until the first administration of rescue opioid. Rescue analgesia is triggered when a trained blinded observer records a Face, Legs, Activity, Cry, Consolability (FLACC) behavioral pain score greater than 3 on two consecutive assessments separated by 15 minutes.

    Measured: Up to 24 hours postoperatively

Secondary outcomes (11)
  1. Postoperative FLACC Pain Scores

    Assessed using the validated Face, Legs, Activity, Cry, Consolability (FLACC) behavioral pain scale (total score range: 0 to 10; higher scores indicate greater pain intensity). Recorded at discrete in-hospital time points.

    Measured: At PACU arrival (0 hours), 1, 2, 4, and 6 hours postoperatively

  2. Area Under the Curve (AUC) of Postoperative FLACC Pain Scores

    Calculated using the trapezoidal rule from serial FLACC pain scores (range 0-10) recorded over the first 6 post-anesthesia hours to derive cumulative pain exposure (score·hours).

    Measured: From PACU arrival (0 hours) through 6 hours postoperatively

  3. Percentage of Participants Requiring Postoperative Rescue Opioids

    Measured as the proportion of participants in each group who receive at least one dose of rescue opioid analgesia within the observation window.

    Measured: Up to 24 hours postoperatively

  4. Total Cumulative 24-Hour Postoperative Opioid Consumption

    Cumulative intravenous and oral rescue opioid consumption converted to standard Morphine Milligram Equivalents per kilogram of body weight (MME/kg).

    Measured: 24 hours postoperatively

  5. Total Intraoperative Fentanyl Consumption

    Total dose of intravenous fentanyl administered intraoperatively for rescue hemodynamic responses (heart rate or mean arterial pressure > 20% above baseline), expressed in micrograms per kilogram (µg/kg).

    Measured: Intraoperatively (from surgical incision to skin closure)

  6. Incidence of Postoperative Nausea and Vomiting (PONV)

    Percentage of participants experiencing at least one episode of postoperative nausea or vomiting requiring antiemetic treatment.

    Measured: Up to 24 hours postoperatively

  7. Time to First Mobilization

    Measured in hours from the end of anesthesia to first unassisted/age-appropriate ambulation

    Measured: Up to 24 hours postoperatively

  8. Parental Satisfaction Score at 24 Hours

    Assessed via structured telephone follow-up using a 5-point Likert scale (1 = Very Dissatisfied, 5 = Very Satisfied; higher scores indicate greater satisfaction).

    Measured: 24 hours postoperatively

  9. Incidence of Block-Related and Anesthetic Adverse Events

    Percentage of participants experiencing block-related or systemic complications, including local anesthetic systemic toxicity (LAST), vascular puncture, hematoma, local infection, pneumothorax, or urinary retention requiring catheterization.

    Measured: Up to 24 hours postoperatively

  10. Incidence of Postoperative Lower Extremity Motor Blockade

    Assessed using a modified Bromage scale or age-appropriate motor strength score (ability to flex knees and ankles) prior to discharge to confirm complete absence of lower limb motor weakness.

    Measured: At PACU arrival, 2 hours postoperatively, and prior to discharge (up to 24 hours)

  11. Time to Hospital Discharge Readiness

    Measured as the time duration (in hours) from the end of general anesthesia (extubation) until achievement of standard discharge criteria (Modified Aldrete score ≥ 9, stable vital signs for ≥ 1 hour, FLACC pain score ≤ 3 on scheduled non-opioid analgesics alone, adequate oral fluid intake without intractable nausea or vomiting, and absence of active surgical or regional block complications

    Measured: Up to 24 hours postoperatively

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted4 Nov 2026
  2. Study startNov 2026 (estimated)
  3. Primary completionApr 2027 (estimated)
  4. Study completionMay 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Triple blind
Who is masked
Participant, Care provider, Outcomes assessor
Enrolment
90 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07916233
Sponsor's protocol ID
FMBSUREC/07062026/ Mikhael
Status last verified
Oct 2026
First submitted
29 Oct 2026
Last updated
4 Nov 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: De-identified individual participant data collected during the trial, including baseline demographic characteristics, primary outcome measurements (time to first rescue analgesia), serial FLACC pain scores, cumulative opioid consumption, and recorded adverse events, will be made available upon reasonable request.

Questions about this trial

What is this clinical trial studying?

A study testing Ultrasound-guided Lumbar Erector Spinae Plane Block (ESPB) and Ultrasound-guided Transversus Abdominis Plane (TAP) Block in people with Inguinal Hernia and Postoperative Pain, run by Beni-Suef University at 1 site in Egypt.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 9 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: opening soon, as of the sponsor's last update on 4 Nov 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Egypt. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Kerollos Moneer Neseem Mikhael, MD (00201288549959, Kmnmk87@med.bsu.edu.eg), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Time to First Postoperative Rescue Analgesia Request (time frame: Up to 24 hours postoperatively). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 Nov 2026.

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