Journal Article

Ultrasound guided quadratus lumborum block versus interlaminar epidural block for analgesia in pediatric abdominal surgery: a randomized controlled trial

Sultan, Mohamed Ahmed, Mokbel, Ehab Mohamed, Moawad, Hazem El Sayed, Wageh, Mohamed, Alseoudy, Mahmoud Mohammed

2024

Overview

Background Although the efficacy and safety of epidural block (EB) are fairly high, complications such as inadvertent dural puncture may limit its use. Ultrasound-guided quadratus lumborum block (QLB) is a relatively new regional technique that provides perioperative somatic and visceral analgesia for pediatric patients. This trial compared the quality of pain relief in pediatric patients undergoing abdominal surgery who received either QLB or EB. Methods Patients were randomly allocated into two equal groups: Group E( n  = 29): received EB; Group QL( n  = 29): received QLB. Both groups were injected with 0.25% bupivacaine (0.5 ml/kg). Assessment of total analgesia consumption was the primary outcome measure, whereas the secondary outcome measures were assessment of postoperative analgesic effect by Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS) and time of first analgesic request. Results Our study showed that the mean total fentanyl consumption was comparable between both groups(38.67 ± 5.02 and 36.47 ± 5.13 µg in the E and QL groups, respectively, P  = 0.246). Only five patients did not require rescue analgesia (3 in the E group,2 in the QL group, P  = 0.378). The mean duration of analgesia showed no significant difference between the two groups (9.9 ± 1.58 and 11.02 ± 1.74 h in the E and QL groups, respectively, P  = 0.212). Evaluation of CHEOPS score values immediately in PACU and for the initial 24 h following operation showed no significant difference between the two study groups( P  > 0.05). Conclusion QLB can achieve analgesic effects comparable to those of EB as a crucial part of multimodal analgesia in children undergoing abdominal surgeries. Clinical trial registration number PACTR202203906027106.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Abdomen / Abdomen - surgery / Abdominal Muscles - diagnostic imaging / Abdominal surgery / Analgesia / Analgesia, Epidural - methods / Analgesics / Analgesics, Opioid - administration & dosage / Anesthesiology / Anesthetics, Local - administration & dosage / Bupivacaine / Bupivacaine - administration & dosage / Care and treatment / Child / Child, Preschool / Children / Comparative analysis / Critical Care Medicine / Emergency Medicine / Epidural / Epidural block / Female / Fentanyl / Fentanyl - administration & dosage / General anesthesia / Health aspects / Humans / Intensive / Internal Medicine / Male / Medical care / Medicine / Medicine & Public Health / Nerve Block - methods / Pain / Pain perception / Parents & parenting / Patients / Pediatric / Pediatrics / Post-Operative Pain Control / Postoperative Pain - prevention & control / Quadratus lumborum block / Quality management / Statistical analysis / Surgery / Ultrasonic imaging / Ultrasonography, Interventional - methods / Ultrasound