Comparison of three quadratus lumborum block approaches for pediatric lower abdominal surgeries: a randomized controlled trial
Comparação de três abordagens do bloqueio do quadrado lombar em cirurgias abdominais inferiores pediátricas: um ensaio clínico randomizado
Arun SK, Ajeet Kumar, Amarjeet Kumar, Chandni Sinha, Abhyuday Kumar, Poonam Kumari, Bindey Kumar
Abstract
Background
Lower abdominal surgeries in the pediatric population are associated with significant postoperative 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.
Methods
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.
Results
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.
Conclusion
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.
Keywords
Resumo
Introdução
As cirurgias abdominais inferiores na população pediátrica estão associadas à dor pós-operatória significativa. Técnicas de anestesia regional, incluindo o bloqueio do nervo ílioinguinal, o bloqueio do plano do músculo transverso do abdome (TAP) e o bloqueio do quadrado lombar (QL) têm sido exploradas para essas cirurgias. Este estudo compara o efeito analgésico de três diferentes abordagens do bloqueio do quadrado lombar em pacientes pediátricos submetidos a cirurgias abdominais inferiores.
Métodos
Este ensaio clínico randomizado incluiu 120 pacientes pediátricos com idades entre 1 e 7 anos, agendados para cirurgia abdominal inferior sob anestesia geral. Os pacientes foram randomizados em 3 grupos. Os pacientes do Grupo A receberam o bloqueio QL pela abordagem anterior, o Grupo L pela abordagem lateral e o Grupo P pela abordagem posterior. Um volume de 0,5 mL·kg⁻¹ de ropivacaína a 0,375% foi injetado unilateralmente para o bloqueio QL em todos os pacientes. O desfecho primário foi o consumo de fentanil nas 24 horas pós-operatórias. Os desfechos secundários incluíram o uso intraoperatório de fentanil, escores de dor pós-operatória, tempo até a analgesia de resgate e satisfação dos pais.
Resultados
O consumo médio de fentanil pós-operatório foi significativamente menor no Grupo A em comparação com o Grupo L (p < 0,001) e o Grupo P (p < 0,011). Os escores medianos de FLACC pós-operatórios foram significativamente menores (p < 0,05) no Grupo A em comparação com os Grupos L e P no período pós-operatório inicial. O escore de satisfação dos pais foi significativamente maior (p < 0,05) no Grupo A.
Conclusion
A abordagem anterior do bloqueio QL reduz o consumo de analgésicos pós-operatórios e proporciona maior duração da analgesia, além de melhores escores de satisfação dos pais, em comparação com as abordagens lateral e posterior em pacientes pediátricos submetidos a cirurgias abdominais inferiores.
Palavras-chave
References
1. De Negri P, Ivani G, Tirri T, Favullo L, Nardelli A. New drugs, new techniques, new indications in pediatric regional anesthesia. Minerva Anestesiol. 2002;68:420−7.
2. Aksu C, Gurkan Y. Ultrasound guided quadratus lumborum block € for postoperative analgesia in pediatric ambulatory inguinal hernia repair. J Clin Anesth. 2018;46:77−8.
3. Fredrickson MJ, Paine C, Hamill J. Improved analgesia with the ilioinguinal block compared to the transversus abdominis plane block after pediatric inguinal surgery: a prospective randomized trial. Paediatr Anaesth. 2010;20:1022−7.
4. Okur O, Karaduman D, Tekgul ZT, Koroglu N, Yildirim M. Posterior quadratus lumborum versus transversus abdominis plane block for inguinal hernia repair: a prospective randomized controlled study. Braz J Anesthesiol. 2021;71:505−10.
5. Mutlu OPZ, Tutuncu AC, Kendigelen P, Kara Esen B. Posterior transversus abdominis plane block versus lateral quadratus lumborum block in children undergoing open orchiopexy: a randomized clinical trial. Braz J Anesthesiol. 2024;74:744443.
6. Blanco R, Ansari T, Girgis E. Quadratus lumborum block for postoperative pain after caesarean section: A randomised controlled trial. Eur J Anaesthesiol. 2015;32:812−8.
7. Blanco R, Ansari T, Riad W, Shetty N. Quadratus lumborum block versus transversus abdominis plane block for postoperative pain after cesarean delivery: A randomized controlled trial. Reg Anesth Pain Med. 2016;41:757−62.
8. Oksuz G, Bilal B, G € urkan Y, et al. Quadratus lumborum block € versus transversus abdominis plane block in children undergoing low abdominal surgery: A randomized controlled trial. Reg Anesth Pain Med. 2017;42:674−9.
9. Ishio J, Komasawa N, Kido H, Minami T. Evaluation of ultrasound-guided posterior quadratus lumborum block for postoperative analgesia after laparoscopic gynecologic surgery. J Clin Anesth. 2017;41:1−4.
10. Elsharkawy H, El-Boghdadly K, Barrington M. Quadratus Lumborum Block: Anatomical Concepts, Mechanisms, and Techniques. Anesthesiology. 2019;130:322−35.
11. Børglum J, Moriggl B, Jensen K, et al. Ultrasound-Guided Transmuscular Quadratus Lumborum Blockade. Br J Anaesth. 2013;111. el_9919.
12. Dam M, Moriggl B, Hansen CK, Hoermann R, Bendtsen TF, Børglum J. The pathway of injectate spread with the transmuscular quadratus lumborum block: A cadaver study. Anesth Analg. 2017;125:303−12.
13. Kumar A, Sinha C, Singh S, Kumar A, Kumar A, Priya D. Comparison of anterior, posterior, and lateral approaches of ultrasound-guided quadratus lumborum block in an adult patient undergoing inguinal hernia surgery: A prospective randomized controlled trial. J Anaesthesiol Clin Pharmacol. 2024;40:457−62.
14. Saracoglu KT, Dal D, Bayg ¸ {n O. Parental Satisfaction Assessment After Paediatric Procedural Sedation: There Are Still Issues to Address. Turk J Anaesthesiol Reanim. 2014;42:332−40.
15. Adhikary SD, El-Boghdadly K, Nasralah Z, Sarwani N, Nixon AM, Chin KJ. A radiologic and anatomic assessment of injectate spread following transmuscular quadratus lumborum block in cadavers. Anaesthesia. 2017;72:73−9.
16. Dam M, Moriggl B, Hansen CK, Hoermann R, Bendtsen TF, Børglum J. The pathway of injectate spread with the transmuscular quadratus lumborum block: A cadaver study. Anesth Analg. 2017;125:303−12.
17. Carline L, McLeod G, Lamb C. A cadaver study comparing spread of dye and nerve involvement after three different quadratus lumborum blocks. Br J Anaesth. 2016;117:387‑94.
18. Elsharkawy H, El-Boghdadly K, Kolli S, et al. Injectate spread following anterior sub-costal and posterior approaches to the quadratus lumborum block: A comparative cadaveric study. Eur J Anaesthesiol. 2017;34:587−95.
19. Sato M. Ultrasound-guided quadratus lumborum block compared to caudal ropivacaine/morphine in children undergoing surgery for vesicoureteric reflex. Paediatr Anaesth. 2019;29:738−43.
20. Aksu C, Gurkan Y. Ultrasound guided quadratus lumborum block € for postoperative analgesia in pediatric ambulatory inguinal hernia repair. J Clin Anesth. 2018;46:77−8.
21. Ahmed A, Fawzy M, Nasr MAR, et al. Ultrasound-guided quadratus lumborum block for postoperative pain control in patients undergoing unilateral inguinal hernia repair, a comparative study between two approaches. BMC Anesthesiol. 2019;19:184.
22. Chakraborty A, Goswami J, Patro V. Ultrasound‑guided continuous quadratus lumborum block for postoperative analgesia in a pediatric patient. A A Case Pract. 2015;4:34‑6.
Submitted date:
02/11/2025
Accepted date:
08/20/2025
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email