Ultrasound-guided Quadratus Lumborum Block versus caudal block for postoperative analgesia in children undergoing acute appendicitis: a comparative study

Authors

  • D V Dmytriiev National Pirogov Memorial Medical University, Vinnytsia
  • E O Glazov Regional Children’s Clinical Hospital, Odessa
  • B V Zaletskyi National Pirogov Memorial Medical University, Vinnytsia
  • K Y Dmytriieva National Pirogov Memorial Medical University, Vinnytsia

DOI:

https://doi.org/10.31636/pmjua.v5i4.4

Keywords:

caudal block, acute appendicitis, US-guided Quadratus Lumborum Block (QLB)

Abstract

Background: ultrasound (US)-guided Quadratus Lumborum Block (QLB) is an effective technique in providing analgesia for abdominal surgery. This study was designed to evaluate the efficacy of a US-guided Quadratus Lumborum Block (QLB) compare it with a caudal block in children after acute appendicitis.

Patients and methods. Forty eight (48) ASA 1–2, 1–5-year-old children scheduled for elective acute appendicites 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 Quadratus Lumborum Block (QLB) (n = 24) (group Q) using 0.5 ml/kg of 0.25 % bupivacaine, injected on the same side of surgery, and group C received a caudal block using 1 ml/kg of 0.2 % bupivacaine (n = 24). Surgery was allowed 15 min after administration of 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. US-guided Quadratus Lumborum Block (QLB) is as effective as caudal block in providing immediate postoperative analgesia in acute appendicitis.

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References

Ahmed AA, Rayan AA. Ultrasound-guided transversus abdominis plane block versus caudal block for postoperative analgesia in children undergoing unilateral open inguinal herniotomy: A comparative study. Ain-Shams Journal of Anaesthesiology. 2016 Apr 1;9(2):284.

Silvani P, Camporesi A, Agostino MR, Salvo I. Caudal anesthesia in pediatrics: an update. Minerva anestesiologica. 2006 Jun;72(6):453.

McDonnell JG, ODonnell B, Curley G, Heffernan A, Power C, Laffey JG. The Analgesic Efficacy of Transversus Abdominis Plane Block After Abdominal Surgery: A Prospective Randomized Controlled Trial. Anesthesia & Analgesia [Internet]. Ovid Technologies (Wolters Kluwer Health); 2007 Jan;104(1):193–7. Available from: https://doi.org/10.1213/01.ane.0000250223.49963.0f

Marhofer P, Sitzwohl C, Greher M, Kapral S. Ultrasound guidance for infraclavicular brachial plexus anaesthesia in children. Anaesthesia [Internet]. Wiley; 2004 Jul;59(7):642–6. Available from: https://doi.org/10.1111/j.1365-2044.2004.03669.x

Battner W, Finke W. Analysis of behavioural and physiological parameters for the assessment of postoperative analgesic demand in newborns, infants and young children: a comprehensive report on seven consecutive studies. Pediatric Anesthesia [Internet]. Wiley; 2000 May;10(3):303–18. Available from: https://doi.org/10.1046/j.1460-9592.2000.00530.x

Willard FH, Vleeming A, Schuenke MD, Danneels L, Schleip R. The thoracolumbar fascia: anatomy, function and clinical considerations. Journal of Anatomy [Internet]. Wiley; 2012 May 27;221(6):507–36. Available from: https://doi.org/10.1111/j.1469-7580.2012.01511.x

El-Boghdadly K, Elsharkawy H, Short A, Chin KJ. Quadratus Lumborum Block Nomenclature and Anatomical Considerations. Regional Anesthesia and Pain Medicine [Internet]. BMJ; 2016;41(4):548–9. Available from: https://doi.org/10.1097/aap.0000000000000411

Elsharkawy H. Quadratus lumborum block with paramedian sagittal oblique (subcostal) approach. Anaesthesia [Internet]. Wiley; 2016 Jan 11;71(2):241–2. Available from: https://doi.org/10.1111/anae.13371

Blanco R, Ansari T, Riad W, Shetty N. Quadratus Lumborum Block Versus Transversus Abdominis Plane Block for Postoperative Pain After Cesarean Delivery. Regional Anesthesia and Pain Medicine [Internet]. BMJ; 2016;41(6):757–62. Available from: https://doi.org/10.1097/aap.0000000000000495

Lin J-A, Lu H-T. A convenient alternative for monitoring opening pressure during multiple needle redirection. British Journal of Anaesthesia [Internet]. Elsevier BV; 2014 Apr;112(4):771–2. Available from: https://doi.org/10.1093/bja/aeu083

Lin J-A. Importance of half-the-air pressure test in Shamrock lumbar plexus block. European Journal of Anaesthesiology [Internet]. Ovid Technologies (Wolters Kluwer Health); 2016 Oct;33(10):784. Available from: https://doi.org/10.1097/eja.0000000000000465

Lin J-A, Chuang T-Y, Yao H-Y, Yang S-F, Tai Y-T. Ultrasound standard of peripheral nerve block for shoulder arthroscopy: a single-penetration double-injection approach targeting the superior trunk and supraclavicular nerve in the lateral decubitus position. British Journal of Anaesthesia [Internet]. Elsevier BV; 2015 Dec;115(6):932–4. Available from: https://doi.org/10.1093/bja/aev384

Baidya DK, Maitra S, Arora MK, Agarwal A. Quadratus lumborum block: an effective method of perioperative analgesia in children undergoing pyeloplasty. Journal of Clinical Anesthesia [Internet]. Elsevier BV; 2015 Dec;27(8):694–6. Available from: https://doi.org/10.1016/j.jclinane.2015.05.006

Ultrasound-guided Quadratus Lumborum Block versus caudal block for postoperative analgesia in children undergoing acute appendicitis: a comparative study

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Published

2021-03-11

How to Cite

1.
Dmytriiev DV, Glazov EO, Zaletskyi BV, Dmytriieva KY. Ultrasound-guided Quadratus Lumborum Block versus caudal block for postoperative analgesia in children undergoing acute appendicitis: a comparative study. PMJUA [Internet]. 2021 Mar. 11 [cited 2024 Mar. 29];5(4):23-9. Available from: https://painmedicine.org.ua/index.php/pnmdcn/article/view/239

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