Comparison of three quadratus lumborum block approaches for pediatric lower abdominal surgeries: a randomized controlled trial

TL;DR

This study compares three methods of a pain-blocking technique in children after lower abdominal surgery, finding that one method provides better pain relief and higher parental satisfaction.

Contribution

The study is the first to compare three quadratus lumborum block approaches in pediatric lower abdominal surgeries using a randomized controlled trial.

Findings

The anterior approach to QL block significantly reduced postoperative fentanyl consumption compared to lateral and posterior approaches.

The anterior approach resulted in lower postoperative pain scores and higher parental satisfaction.

The anterior approach provided longer duration analgesia in pediatric patients.

Abstract

Lower abdominal surgeries in the pediatric population are associated with significant post-operative pain. Regional anesthesia techniques including ilioinguinal nerve block, Transversus Abdominis Plane (TAP) block, and Quadratus Lumborum (QL) block have been explored for lower abdominal surgeries. This study compares the analgesic effect of three different approaches to quadratus lumborum block in pediatric patients undergoing lower abdominal surgeries.

This randomized controlled trial included 120 pediatric patients aged between 1 and 7 years, scheduled for lower abdominal surgery under general anesthesia. Patients were randomized into 3 groups. Patients of Group A received QL block via anterior approach, Group L received QL block via lateral approach, and Group P received QL block via posterior approach. A volume of 0.5 mL.kg-1 of 0.375% ropivacaine was injected unilaterally for QL block in all patients. The primary outcome was 24hr postoperative fentanyl consumption. Secondary outcomes included intraoperative fentanyl use, postoperative pain scores, time to rescue analgesia and parental satisfaction.

Postoperative mean fentanyl consumption was significantly lower in Group A as compared to Group L (p < 0.001) and Group P (p < 0.011). Postoperative median FLACC scores were significantly lower (p < 0.05) in Group A in comparison to Group L and Group P in the early postoperative period. The parent satisfaction score was significantly higher (p < 0.05) in Group A.

Anterior approach to QL block reduces postoperative analgesic consumption and provides longer duration analgesia with better parental satisfaction scores in comparison to lateral and posterior approaches in pediatric patients undergoing lower abdominal surgeries.

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