Lateral versus posterior quadratus lumborum block in children undergoing open orchiopexy: a double-blind randomized clinical trial
Bloqueio do quadrado lombar lateral versus posterior em crianças submetidas à orquidopexia aberta: um ensaio clínico randomizado duplo-cego
Ozgecan P. Zanbak Mutlu, Pinar Kendigelen, Ayse C. Tutuncu
Abstract
Background
Quadratus Lumborum Block (QLB) has recently become an effective analgesic regional technique frequently used in abdominal surgeries. However, due to the heterogeneity in studies regarding block approaches, a direct comparison of QLB types is needed. In this double-blind prospective randomized trial, we aimed to compare the effects of lateral and posterior approaches of QLB on pain and analgesic use in children undergoing orchiopexy.
Methods
Patients aged 6 months − 12 years undergoing elective unilateral open orchiopexy were included in the study. Patients were randomized into two groups using the closed-envelope method. Lateral or posterior QLB was applied under ultrasonography with 0.4 mL/kg 0.25% bupivacaine for both groups before the surgery. The primary outcome was the assessment of postoperative pain for 24 hours. Analgesic usage, parental satisfaction, and complications were recorded as secondary outcomes.
Results
Analyses were conducted on 80 patients. Both study groups achieved clinically adequate analgesia, and no significant pain score distinctions were observed within 24 hours (Total mean scores: FLACC [lateral QLB: 2.86 ± 4.69 vs. posterior QLB: 2.87 ± 3.71, p = 0.466], Wong-Baker [lateral QLB: 0.86 ± 2.03 vs. posterior QLB: 1.24 ± 1.85, p = 0.151]). No significant interaction effect between groups and postoperative time intervals on pain scores was observed (FLACC score p-interaction: 0.425, Wong-Baker score p-interaction: 0.451). There were no statistical differences in the number of patients necessitating intraoperative and postoperative analgesics. Parental satisfaction exhibited similarity between the groups, and no perioperative complications were observed in either group.
Conclusion
Lateral and posterior QLB provided similar perioperative analgesia in pediatric patients undergoing orchiopexy. Clinical trial registration number: NCT05056038. Date of registration: 02 June 2021.
Keywords
Resumo
Introdução
O bloqueio do quadrado lombar (QLB) tornou-se recentemente uma técnica analgésica regional eficaz, frequentemente utilizada em cirurgias abdominais. No entanto, devido à heterogeneidade dos estudos quanto às abordagens do bloqueio, é necessária uma comparação direta entre os tipos de QLB. Neste ensaio clínico randomizado prospectivo duplo-cego, nosso objetivo foi comparar os efeitos das abordagens lateral e posterior do QLB sobre a dor e o uso de analgésicos em crianças submetidas à orquidopexia.
Métodos
Foram incluídos no estudo pacientes com idades entre 6 meses e 12 anos submetidos à orquidopexia aberta unilateral eletiva. Os pacientes foram randomizados em dois grupos por meio do método de envelope fechado. O QLB lateral ou posterior foi aplicado sob ultrassonografia com 0,4 mL·kg⁻¹ de bupivacaína a 0,25% para ambos os grupos antes da cirurgia. O desfecho primário foi a avaliação da dor pós-operatória durante 24 horas. O uso de analgésicos, a satisfação dos pais e as complicações foram registrados como desfechos secundários.
Resultados
As análises foram realizadas em 80 pacientes. Ambos os grupos apresentaram analgesia clinicamente adequada, sem diferenças significativas nos escores de dor ao longo de 24 horas (médias totais: FLACC [QLB lateral: 2,86 ± 4,69 vs. QLB posterior: 2,87 ± 3,71, p = 0,466], Wong-Baker [QLB lateral: 0,86 ± 2,03 vs. QLB posterior: 1,24 ± 1,85, p = 0,151]). Não houve efeito de interação significativo entre os grupos e os intervalos de tempo pós-operatórios nos escores de dor (FLACC p-interação: 0,425; Wong-Baker p-interação: 0,451). Não foram observadas diferenças estatísticas no número de pacientes que necessitaram de analgésicos intraoperatórios e pós-operatórios. A satisfação dos pais foi semelhante entre os grupos, e não ocorreram complicações perioperatórias em nenhum deles.
Conclusion
As abordagens lateral e posterior do QLB proporcionaram analgesia perioperatória semelhante em pacientes pediátricos submetidos à orquidopexia.
Número de registro do ensaio clínico
NCT05056038.
Data de registro
2 de junho de 2021.
Palavras-chave
Referências
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Submetido em:
07/02/2025
Aceito em:
01/07/2025
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