Comparison Of Postoperative Pain Between Ultrasound-Guided Quadratus Lumborum Block Versus Ultrasound-Guided Caudal Epidural Block In Children 1-6 Years Old Undergoing Unilateral Lower Abdominal And Urological Surgeries In Philippine Children’s Medi
Aubrey Yumang | Janette Pascual | Michael D Cabato
Discipline: medicine by specialism
Abstract:
BACKGROUND: Ultrasound?guided quadratus lumborum block (QLB) is a regional anesthetic
technique which can provide post op pain control for pediatric patients undergoing abdominal
surgery. We hypothesized that the quadratus lumborum block would be as efficacious as a caudal
block in providing pain control.
OBJECTIVE: To compare the postoperative analgesic effect of ultrasound-guided QLB versus
ultrasound-guided caudal block among 1-6 years old children undergoing lower abdominal and
urological surgeries in Philippine Children‘s Medical Center.
METHODS: This is a single blinded randomized control trial. 50 patients enrolled aged between
1 and 6 years. The patients were randomly classified into the caudal block group and quadratus
lumborum block group. The primary outcome is the need for analgesia during the first 24 hours.
RESULTS: A significant difference in the proportion of patients who requested for rescue
analgesia was observed with caudal block having more patients in need of analgesic (100% CB
vs 48% QLB, p<0.001). No postoperative complication was observed.
CONCLUSIONS AND RECOMMENDATIONS: The quadratus lumborum block was more
effective in reducing the postoperative pain management during the initial 48 hours. Quadratus
lumborum block is recommended for future pediatric procedures requiring postoperative pain
control, safety, practicality and economy.
References:
- Hobson A, Wiffen PJ, Conlon JA. As required versus fixed schedule analgesic administration for postoperative pain in children. Cochrane Database of Systematic Reviews 2015, Issue 2. Art. No.: CD011404. DOI: 10.1002/14651858.CD011404.pub2
- Faul, F., Erdfelder, E., Lang, A.-G. & Buchner, A. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39, 175-191
- Dogra,N.,et al A study to compare caudal levobupivacaine, tramadol and a combination of both in paediatric inguinal hernia surgeries, Indian Journal of Anesthesia May 2018, v62,I5, 359-
- Öksüz, G., Bilal, B., Gürkan, Y., Urfalioğlu, A., Arslan, M., Gişi, G., &Öksüz, H. (2017). Quadratus Lumborum Block in Children Undergoing Low Abdominal Surgery. Regional Anesthesia and Pain Medicine, 42(5), 674–679.
- S. Merkel et al,. The FLACC: A behavioral scale for scoring postoperative pain in young children, Pediatric Nurse 23,p. 293–297) 1997.
- Von Baeyer, C. L., Chambers, C. T., & Eakins, D. M. (2011). Development of a 10- Item Short Form of the Parents‘ Postoperative Pain Measure: The PPPM-SF. The Journal of Pain, 12(3), 401–406. doi:10.1016/j.jpain.2010.10.002
- Blanco, R. (2007) Tap Block under Ultrasound Guidance: The Description of a “No Pops” Technique. Regional Anesthesia and Pain Medicine, 32, 130.
- R. Blanco, T. Ansari, and E. Girgis,―Quadratus lumborum block for postoperative pain after caesarean section: a randomised controlled trial,‖ European Journal of Anaesthesiology, vol. 32, no. 11, pp. 812–818, 2015.
- Visoiu M, Yakovleva N: Continuous postoperative analgesia via quadratus lumborum block—An alternative to transversus abdominis plane block. PaediatricAnaesthesia 2013;23:959–961.
- Chakraborty, J. Goswami, and V. Patro,―Ultrasound-guided continuous quadratus lumborum block for postoperative analgesia in a pediatric patient,‖ A & A Case Reports, vol. 4, no. 3, pp. 34–36, 2015
- D. K. Baidya, S. Maitra, M. K. Arora, and A. Agarwal, ―Quadratus lumborum block: an effective method of perioperative analgesia in children undergoing pyeloplasty,‖ Journal of Clinical Anesthesia, vol. 27, no. 8, pp. 694–696, 2015.
- Murouchi, ―Quadratus lumborum block intramuscular approach for pediatric surgery,‖ ActaAnaesthesiologica Taiwanica, 2016.
- T. Murouchi, S. Iwasaki, and M. Yamakage, ―Quadratus lumborum block: analgesic effects and chronological ropivacaine concentrations after laparoscopic surgery, Regional Anesthesia and Pain Medicine, vol. 41, no. 2 pp.146- 150, 2016.L. Carline, G. A. McLeod, C. Lamb, and L. Colvin, ―A cadaver study comparing spread of dye and nerve involvement after three different quadratus lumborum blocks,‖ British Journal of Anaesthesia, vol.
- North, KN, Laing, NG, & Wallgren-Petterson, C. Nemaline Myopathy: Current Concepts. Journal of Medical Genetics. 1997; 34(9): 705-713.
- Ryan, I et al. Clinical Course Correlates Poorly with Muscle Pathology in Nemaline Myopathy. Neurology PubMed. 2003; 60(4): 665-673.
- Ueda, K et al. A Mutation in ACTA1 Gene Manifesting Nemaline Myopathy with CNS Lesions. Journal of Clinical Neurology. 2017; 13(3): 300-302.
- Wang, CH et al. Consensus Statement on Standard of Care for Congenital Myopathies. Journal of Child Neurology. 2017; 27(3): 363-382.
- Ryan, NM et al. Nemaline Myopathy: A Clinical Study of 143 Cases. Annals of Neurology. 2001; 50(3): 312-320.
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