Ultrasound-guided quadratus lumborum block versus caudal block for perioperative analgesia in children after minimal invasive surgery

Abstract

Background: Ultrasound (US)-guided Quadratus Lumborum (QLB) block is an effective technique in providing analgesia for abdominal surgery. This study was designed to evaluate the efficacy of a US-guided QLB compare it with a caudal block in undergoing major abdominal surgery in children. Patients and Methods. 128 ASA 1-2, 1-14-year-old children scheduled for elective acute diseases of the abdominal cavity were studied. All patients received general anesthesia; sevoflurane was used for induction and maintenance of anesthesia and laryngeal mask airway (LMA) was used to secure the airway. After securing an intravenous cannula, patients were randomized to a US-guided QLB (n = 64) (group Q) using 0.5 ml/kg 0.25% bupivacaine, injected on the same side of surgery, and group C received a caudal block using 1 ml/kg 0.2% bupivacaine (n = 64). Surgery was allowed 15 min after administration the block. Block failure was considered in case of gross movement or more than 20% change in heart rate and/or ABP persisting more than 1 min after skin incision. Any adverse events were recorded. After surgery, patients remained for 4 h in the recovery room. Postoperative analgesia was evaluated using Children and Infants Postoperative Pain Scale (CHIPPS). An anesthesiologist, who was not part of the study team, evaluated the need for rescue analgesia in the intraoperative and postoperative period and a recovery nurse collected the data. If the CHIPPS score was greater than 4, a rescue analgesia of 20 mg/kg acetaminophen was administered.

Results: No difference was found in hemodynamics in both groups. Also, intraoperative fentanyl consumption was not different and no rescue analgesia was required in the postanesthesia care unit.

Conclusion: A US-guided QLB is as effective as a caudal block in providing immediate postoperative analgesia in acute diseases of the abdominal cavity.