Ultrasound-guided quadratus lumborum block in pediatrics: trans-muscular versus intra-muscular approach

Hussein, Mostafa M

doi:10.1007/s00540-018-2563-z

Cited by 23 publications

(23 citation statements)

References 17 publications

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“…QLB includes the QLB1 and QLB2, transmuscular quadratus lumborum, and intramuscular quadratus lumborum block (IMQL) approach 5 6 22 23. Hussein compared transmuscular quadratus lumborum block and IMQL in lower abdominal surgeries and reported that transmuscular quadratus lumborum block was more effective 24. In our clinic, we used the QLB2 block because it is both safe and effective.…”

Section: Discussionmentioning

confidence: 99%

Comparison of quadratus lumborum block and caudal block for postoperative analgesia in pediatric patients undergoing inguinal hernia repair and orchiopexy surgeries: a randomized controlled trial

Öksüz

Arslan

Urfalıoğlu

et al. 2020

Reg Anesth Pain Med

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Background and objectivesCaudal epidural anesthesia is a widely used popular technique for postoperative analgesia but it has potential side effects and duration of analgesia is short. Quadratus lumborum block (QLB) was found to be an effective method for postoperative analgesia in lower abdominal surgeries. In this double-blind prospective randomized trial, we aimed to compare the postoperative analgesic efficacies of QLB and the caudal block in pediatric patients undergoing inguinal hernia repair and orchiopexy surgeries under general anesthesia.Materials and methodsAfter approval was obtained from the ethics committee, in this prospective randomized double-blind trial, 53 patients under general anesthesia undergoing inguinal hernia repair and orchiopexy surgeries randomly received caudal block or QLB. Demographic data, postoperative analgesic requirement, Face, Legs, Activity, Cry, and Consolability (FLACC) scores at 30 min, 1, 2, 4, 6, 12 and 24 hours, parent satisfaction scores and complications were recorded.ResultsThe study included 52 patients, after excluding one patient because of a failed caudal block. There were no significant differences between the groups based on demographic data (p>0.05). The number of patients who required analgesics in the first 24 hours was significantly lower in QLB group (p=0.001). Postoperative 4, 6, 12 hours FLACC scores were significantly lower in the QLB group (p<0.001, p=0.001 and p<0.001, respectively). Parent satisfaction scores were higher in the QLB group (p=0.014).ConclusionAccording to the results of this study, QLB can provide much more effective analgesia than caudal block without adjuvants in multimodal analgesia management of children undergoing inguinal hernia repair and orchiopexy surgeries.Trial registration numberNCT03294291.

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Section: Discussionmentioning

confidence: 99%

Comparison of quadratus lumborum block and caudal block for postoperative analgesia in pediatric patients undergoing inguinal hernia repair and orchiopexy surgeries: a randomized controlled trial

Öksüz

Arslan

Urfalıoğlu

et al. 2020

Reg Anesth Pain Med

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“…A similar, clinical study is currently being undertaken by our group to validate these findings in pediatrics. Moreover, a recent study of the QL block in pediatric patients showed that some patients experienced weakness in the quadriceps (3.7%‐29.6%) . This finding should be borne in mind especially for patients scheduled for day case surgery (eg, hernia repair and orchiopexy).…”

Section: Discussionmentioning

confidence: 99%

Ultrasound‐guided quadratus lumborum block compared to caudal ropivacaine/morphine in children undergoing surgery for vesicoureteric reflex

Sato

2019

Pediatric Anesthesia

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Ureteral reimplantation (ureteroneocystostomy) for vesicoureteric reflex is an archetypal lower abdominal operation performed via a transverse incision in pediatric cases. Postoperatively, patients experience severe somatosensory pain at the incision site and visceral soreness and discomfort arising from bladder spasms.Postoperative analgesia options in children undergoing this type of surgery include regional anesthesia, such as a lumbar epidural catheter, caudal block, or a peripheral nerve block including Abstract Background: Ultrasound-guided quadratus lumborum block is a regional anesthetic technique which can provide perioperative analgesia for all age groups, including pediatric patients undergoing abdominal surgery. We hypothesized that the quadratus lumborum block would be as efficacious as a caudal block, the gold standard of pediatric lower abdominal regional anesthesia, in providing pain control after ureteral reimplantation but also have a longer duration.Methods: Forty-seven pediatric patients between the ages of 1 and 17 years undergoing bilateral ureteral reimplantation surgery via a low transverse incision were enrolled and randomized into the quadratus lumborum block and caudal block groups.All blocks were performed preoperatively under general anesthesia. We analyzed the following outcomes: the requirement for narcotic analgesics, pain score, episodes of emesis, and complications at 0, 4, 24, and 48 hours postoperatively. Results:The study included 44 patients after excluding three who were ineligible. The fentanyl requirement for postoperative rescue analgesia during the first 24 hours was significantly lower in the quadratus lumborum block group than in the caudal block group (median [interquartile range]: 0 [0-1] vs 3 [0-5], P = 0.016, 95% confidence intervals: −4 to 0) but not at 30 minutes, 4, or 48 hours. No significant difference was observed in the pain scores or the incidence of interventions to treat nausea and vomiting during the entire period. No postoperative complication was observed. Conclusion:The quadratus lumborum block was more effective in reducing the postoperative opioid requirement for rescue analgesia during the initial 24 hours than caudal ropivacaine/morphine. K E Y W O R D Scomparative study, epidural analgesia, pediatrics, postoperative pain, prospective study, side effects | RE SULTSThe study included 44 patients after excluding three who were ineligible due to anatomical abnormalities at the site of the nerve block (a dimple at the site of the caudal block). No significant differences were observed between the groups in terms of sex, age, height, weight, ASA-PS score, or operating time (Table 1). Intraoperatively, patients in Group Q required a maximum remifentanil dosing rate a little more than 1.5 times greater than the patients in Group C to suppress a 20% increase in systolic blood pressure and heart rate over the pre-incision value (0.45 ± 0.11 vs 0.33 ± 0.06, P < 0.001; Table 1).The total number of PNCA fentanyl administrations for rescue analgesia in the 24-...

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“…The mechanisms and analgesic efficacy of different approaches are still controversial. A trial that was excluded, due to the lack of a control group, comparing 2 QL block approaches, anterior and intramuscular, shows that anterior QL blocks are superior to intramuscular blocks, in terms of analgesic effect after pediatric lower laparotomy (29). For adults, the anterior QL block approach also produces more postoperative pain relief and less opioid consumption than the posterior (30) and lateral approaches (31).…”

Section: Agreements and Disagreementsmentioning

confidence: 99%

Quadratus Lumborum Block is an Effective Postoperative Analgesic Technique in Pediatric Patients Undergoing Lower Abdominal Surgery: A Meta-Analysis

Zhao

et al. 2021

Pain Phys

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BACKGROUND: Quadratus lumborum (QL) block has shown promising analgesic efficacy in the adult population in previous meta-analyses. However, the response of the pediatric group to pain stimulation is stronger than that in the adult population, and the management of pediatric pain is constrained by limited available analgesia agents. All data analyzed during this study are collected from published articles. OBJECTIVE: The purpose of our systematic review was to evaluate whether QL block is also an effective postoperative analgesic technique, compared to other analgesic skills in pediatric patients undergoing lower abdominal surgery. STUDY DESIGN: A meta-analysis. METHODS: We identified randomized controlled trials (RCTs) from PubMed, Embase, the Cochrane Library, Web of Science, and Science Direct to compare QL block with other analgesic methods for relief of postoperative pain in pediatric patients undergoing lower abdominal surgeries under general anesthesia. The primary outcome was the rate of postoperative rescue analgesia; secondary outcomes include: pain scores at 30 minutes and 1, 2, 4, 6, 12, and 24 hours postoperatively, patient satisfaction, and block related complications. RESULTS: A total of 7 studies with 346 patients were included. QL block showed a significant reduction in the rate of postoperative rescue analgesia in the first 24 hours (RR = 0.41; 95% CI = 0.28 to 0.59; P < 0.001) compared to other analgesic techniques, without significant heterogeneity among the articles (I2 = 49%, P = 0.08). Compared with other analgesic methods, QL block significantly reduced the pain scores at 2 hours (Std.MD = -0.76; 95% CI = -1.16 to -0.35; P < 0.001) (I2 < 0.001%, P = 0.41), 4 hours (Std.MD = -0.34; 95% CI = -0.67 to -0.01; P = 0.04) (I2 < 0.001%, P = 0.53) and 12 hours postoperatively (Std.MD = -0.95; 95% CI = -1.44 to -0.47; P < 0.001) (I2 = 27%, P = 0.24). No significant differences were found between techniques at 30 minutes and 1, 6, or 24 hours postoperatively (P > 0.05). There was no statistically significant change in patient satisfaction (Std.MD = 0.49; 95% CI = -0.32 to 1.29; P = 0.24) or side effects (RD = -0.02; 95% CI = -0.06 to 0.02; P = 0.31) with QL block. LIMITATIONS: The major limitation of this meta-analysis is the relatively few RCTs and limited results included. Similarly, the differences in block approaches among the control groups (TAP, ESP, caudal block, opioid-based analgesia), drug types and concentrations, and multimodal analgesia programs led to considerable heterogeneity. Furthermore, some relevant outcomes were not investigated. CONCLUSION: Our systematic review and meta-analysis suggests QL block use for the pediatric population undergoing lower abdominal surgery, based on the current limited research evidence, as this method was an effective postoperative analgesic technique. KEY WORDS: Pediatric surgery, postoperative pain, quadratus lumborum block, side effects

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Ultrasound-guided quadratus lumborum block in pediatrics: trans-muscular versus intra-muscular approach

Cited by 23 publications

References 17 publications

Comparison of quadratus lumborum block and caudal block for postoperative analgesia in pediatric patients undergoing inguinal hernia repair and orchiopexy surgeries: a randomized controlled trial

Comparison of quadratus lumborum block and caudal block for postoperative analgesia in pediatric patients undergoing inguinal hernia repair and orchiopexy surgeries: a randomized controlled trial

Ultrasound‐guided quadratus lumborum block compared to caudal ropivacaine/morphine in children undergoing surgery for vesicoureteric reflex

Quadratus Lumborum Block is an Effective Postoperative Analgesic Technique in Pediatric Patients Undergoing Lower Abdominal Surgery: A Meta-Analysis

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