Posterior quadratus lumborum versus caudal epidural block for perioperative analgesia in pediatric patients undergoing upper abdominal surgeries: Arandomized, double-blind trial

ABSTRACT

Background

Ultrasound-guided Quadratus Lumborum block (QLB) has become an established modality for perioperative analgesia in lower abdominal surgeries. However, its efficacy in upper abdominal surgeries is still understudied.

Objectives

The study aimed to determine QLB2 efficacy as a perioperative analgesic modality in upper abdominal surgeries, compared to caudal epidural block (CEB), regarding FLACC score, the time to the first rescue analgesia, the amount of fentanyl consumed intraoperatively, amount of rescue analgesia administered, parents’ satisfaction, as well as the incidence of complications.

Study design

A randomized, prospective, double-blind, and single-center study.

Setting

Ain Shams University Hospitals

Methods/patients/interventions/measurements

Fifty-two pediatric patients scheduled for upper abdominal surgeries under general anesthesia were assigned randomly to undergo CEB or ultrasound guided QLB 2. As assessed by FLACC, postoperative pain scores were the primary outcome. The secondary outcomes included the amount of fentanyl consumed intraoperatively, the time to first rescue analgesia, the amount of rescue analgesia given, parents’ satisfaction, and the incidence of complications.

Results

The QLB cohort demonstrated decreased FLACC scores than the CEB group. Total fentanyl consumption was significantly lower (33.4 ± 14.9 µg vs. 56.5 ± 17.0 µg, p-value of 0.003), time to first rescue analgesia was more prolonged (14.4 ± 1.3hrs vs. 1.8 ± 1.2 hr, p-value <0.001), and parents’ satisfaction was significantly higher. Postoperative nausea incidence was significantly alleviated (11 (42.3%) vs. 22 (84.6%), p-value 0.002), whereas vomiting was substantially decreased (0 (0.0%) vs. 15 (57.7%), p-value <0.001).

Conclusion

Perioperative analgesia in pediatric patients can be effectively achieved using QLB type 2. Compared to CEB, it provides more stable hemodynamics, lower FLACC scores, less need for rescue analgesia, and higher parent satisfaction.

KEYWORDS:

• Pediatric
• pain
• caudal
• quadratus lumborum
• ultrasound
• FLACC

Disclosure statement

No potential conflict of interest was reported by the author(s).

Availability of data and materials

The datasets generated and analyzed for this study are available in the manuscript.

Amr Kasem visualization, supervision, reviewing and editing.

Mohamad TolbaData curation, methodology, investigation, software, writing.

All authors have approved the final version to be published. All authors agree to being accountable for all aspects of the work, ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Authors’ contributions

Based on CRediT criteria: Aya Hisham conceptualization, methodology, writing- original draft preparation.

IRB and clinical trial registration number

The Faculty of Medicine’s Research Ethical Committee at Ain Shams University (FMASU R 69/2022). ClinicalTrials.gov Identifier: NCT05493085.

Additional information

Funding

The authors received no specific grants from funding agencies in the public, commercial, or not-for-profit sector.