Ultrasound-guided Quadratus Lumborum Block versus caudal block for postoperative analgesia in children undergoing acute appendicitis: a comparative study
Keywords:caudal block, acute appendicitis, US-guided Quadratus Lumborum Block (QLB)
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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This work is licensed under a Creative Commons Attribution 4.0 International License