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Ultrasound-guided quadratus lumborum block provided more effective analgesia for children undergoing lower abdominal laparoscopic surgery: a randomized clinical trial

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Abstract

Background

Postoperative pain treatment for pediatrics is often inadequate and the evidence of pediatric postoperative analgesia is scarce. To our knowledge, no report regarding the comparison among caudal block, transversus abdominis plane (TAP) block and quadratus lumborum (QL) block for children undergoing lower abdominal laparoscopic surgery was found at present. Thus this trial aimed to compare the efficacies of them for children undergoing lower abdominal laparoscopic surgery.

Methods

One hundred and eighty children aged from 1 to 12 years undergoing lower abdominal laparoscopic surgery were included and randomized to receive caudal block, TAP block or QL block. The primary outcome was the Face, Legs, Activity, Cry, and Consolability (FLACC) score at 30 min, 1 h, 4 h, 8 h, 12 h, and 24 h and tramadol consumption during first 24 h postoperatively. Secondary outcomes included the number of children received tramadol, time to first tramadol request, parents' satisfaction and postoperative adverse reactions.

Results

The QLB group had lower postoperative FLACC scores at 8 h (median difference − 0.43, P = 0.03) than the Caudal group and at 4 h (median difference − 0.6, P = 0.001) and 8 h (median difference − 0.43, P = 0.03) than the TAPB group. The tramadol consumption was lower in the QLB group (28.43 ± 6.55) than the TAPB group (37.17 ± 6.12, P = 0.023). Although the number of children received tramadol did not differ among the three groups, the time to first tramadol request was longer in the QLB group (7.20 ± 0.79) than the caudal group (8.42 ± 0.61, P = 0.008). No statistical difference was observed concerning other secondary outcomes.

Conclusions

QLB produced more effective postoperative analgesia for children undergoing laparoscopic abdominal surgery compared with the TAPB and caudal block.

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Acknowledgements

We would like to thank the surgical team from the Pediatric Surgery Department, First Affiliated Hospital of Zhengzhou University for their positive cooperation in this trial.

Funding

None.

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Authors and Affiliations

  1. Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1 East Jianshe Road, Zhengzhou, 450052, China

    Yue Zhang, Yan-Ping Wang, Hai-Tao Wang, Yu-Can Xu, Hui-Min Lv, Yang Yu, Peng Wang, Xiang-Dong Pei, Jing-Wei Zhao, Zhen-Hua Nan & Jian-Jun Yang

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  1. Yue Zhang
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  2. Yan-Ping Wang
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  3. Hai-Tao Wang
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  5. Hui-Min Lv
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  6. Yang Yu
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  7. Peng Wang
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  9. Jing-Wei Zhao
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  11. Jian-Jun Yang
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Correspondence to Jian-Jun Yang.

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Disclosure

Yue Zhang, Yan-Ping Wang, Hai-Tao Wang, Yu-Can Xu, Hui-Min Lv, Yang Yu, Peng Wang, Xiang-Dong Pei, Jing-Wei Zhao, Zhen-Hua Nan, Jian-Jun Yang have no conflicts of interests or financial ties to disclose.

Ethical approval

Ethical approval for this trial (approval no. 2020-KY-296) was provided by the Institutional Scientific Research and Clinical Trials Ethics Committee of the First Affiliated Hospital of Zhengzhou University (Chairperson Prof Ying-Pu Sun) on 30 July 2020.

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Zhang, Y., Wang, YP., Wang, HT. et al. Ultrasound-guided quadratus lumborum block provided more effective analgesia for children undergoing lower abdominal laparoscopic surgery: a randomized clinical trial. Surg Endosc 36, 9046–9053 (2022). https://doi.org/10.1007/s00464-022-09370-z

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  • DOI: https://doi.org/10.1007/s00464-022-09370-z

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