Posterior transversus abdominis plane block versus lateral quadratus lumborum block in children undergoing open orchiopexy: a randomized clinical trial
Bloqueio do plano transverso posterior do abdome versus bloqueio do quadrado lombar lateral em crianças submetidas à orquiopexia aberta: ensaio clínico randomizado
Özgecan P. Zanbak Mutlu, Ayşe Ç. Tütüncü, Pınar Kendigelen, Beril Kara Esen
Abstract
Background
Due to the complex innervation of the testicle and spermatic cord, analgesic management can be challenging in orchiopexy. We aimed to compare the effects of posterior Transversus Abdominis Plane (TAP) and lateral Quadratus Lumborum Block (QLB) on analgesic use, pain, and parent satisfaction in unilateral orchiopexy.
Methods
ASA I–III, aged 6 months –to 12 years children undergoing unilateral orchiopexy were included to this double-blinded randomized trial. Patients were randomized into two groups with the closed envelope method before the surgery. Lateral QLB or posterior TAP block was applied under ultrasonography with 0.4 ml.kg−1 0.25% bupivacaine for both groups. The primary outcome was the assessment of additional analgesic usage in the peri-postoperative period. Evaluation of postoperative pain until 24 hours after surgery and parental satisfaction were also assessed as secondary outcomes.
Results
A total of 90 patients were included in the analysis (45 patients in each group). The number of patients needing remifentanil was significantly higher in the TAP group (p < 0.001). The average FLACC (TAP: 2.74 ± 1.8, QLB: 0.7 ± 0.84) and Wong-Baker scores (TAP: 3.13 ± 2.42, QLB: 0.53 ± 1.12) were significantly higher for TAP (p < 0.001). Additional analgesic consumption at the 10th, 20th minutes, 6th, 16th, and 24th hours, especially after the 6th hour, were significantly higher for TAP. Parent satisfaction was significantly higher in the QLB group (p < 0.001).
Conclusion
Lateral QLB provided more effective analgesia than posterior TAP block in children undergoing elective open unilateral orchiopexy.
Clinical Trials Registry: NCT03969316.
Keywords
Resumo
Introdução
Devido à complexa inervação do testículo e do cordão espermático, o manejo analgésico pode ser um desafio na orquiopexia. Nosso objetivo foi comparar os efeitos do plano transverso abdominal posterior (TAP) e do bloqueio lateral do quadrado lombar (BQL) no uso de analgésicos, dor e satisfação dos pais na orquiopexia unilateral.
Métodos
Crianças de 6 meses a 12 anos, estado físico ASA I–III, submetidas à orquiopexia unilateral foram incluídas neste estudo duplo-cego randomizado. Os pacientes foram randomizados em dois grupos pelo método de envelope fechado antes da cirurgia. Bloqueio BQL lateral ou TAP posterior foi aplicado sob ultrassonografia com 0,4 ml.kg−1 de bupivacaína a 0,25% para ambos os grupos. O desfecho primário foi a avaliação do uso adicional de analgésico no período peri-pós-operatório. A avaliação da dor pós-operatória até 24 horas após a cirurgia e a satisfação dos pais também foram avaliadas como desfechos secundários.
Resultados
Um total de 90 pacientes foram incluídos na análise (45 pacientes em cada grupo). O número de pacientes que necessitaram de remifentanil foi significativamente maior no grupo TAP (p < 0,001). As médias dos escores FLACC (TAP: 2,74 ± 1,8, BQL: 0,7 ± 0,84) e Wong-Baker (TAP: 3,13 ± 2,42, BQL: 0,53 ± 1,12) foram significativamente maiores para TAP (p < 0,001). O consumo adicional de analgésico no 10º, 20º minuto, 6a, 16a e 24a horas, principalmente após a 6ª hora, foi significativamente maior para o TAP. A satisfação dos pais foi significativamente maior no grupo BQL (p < 0,001).
Conclusão
O BQL lateral proporcionou analgesia mais eficaz do que o bloqueio TAP posterior em crianças submetidas à orquiopexia unilateral aberta eletiva.
Palavras-chave
Referências
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Submetido em:
26/11/2022
Aceito em:
27/06/2023
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