Background: Postoperative pain management in children can be effectively controlled using regional analgesic techniques. In general, neuraxial blocks pose a higher risk of adverse effects and complications in comparison to peripheral nerve blocks. Recently, both quadratus lumborum block (QLB) and erector spinae plan block (ESPB) have been used to achieve adequate postoperative analgesia in children. We compared the efficacy of both in postoperative pain management after laparoscopic abdominal surgery.
Methodology: Eight five patients with laparoscopic abdominal surgery received either bilateral QLB or ESPB at the level of T8 transverse process with 0.5 ml/kg of 0.25% bupivacaine to achieve adequate postoperative analgesia. FLACC score was used to assess pain score after surgery and the need for rescue opioid analgesia.
Results: The average dose of fentanyl was lower and the time to the first dose of rescue analgesic was longer in QLB group when compared to ESPB group. In addition, FLACC scores were significantly lower in QLB group in comparison to ESPB group at the 6th, 8th, 12th and 20th h after surgery.
Conclusion: Quadratus lumborum block can provide longer and more effective postoperative analgesia in pediatric patients following laparoscopic abdominal surgery in comparison to erector spinae plan block.
Citation: Taman HI, Saber HIES, Farid AM, Elawady MM. Bilateral erector spinae plane block vs quadratus lumborum block for pediatric postoperative pain management after laparoscopic abdominal surgery: a double blinded randomized study. Anaesth. pain intensive care 2022;26(5):602-607; DOI: 10.35975/apic.v26i5.2017
Background: Poor postoperative pain management represents unpleasant experience which occurs in patients following surgical procedure. Recently, there have been increasing efforts to improve the perioperative pain management of children. Objective: To evaluate the paediatric postoperative pain management practice as well as identification of paediatric postoperative pain management influencing factors. Patients and methods: This cross-sectional study was conducted in Mansoura University Children Hospital, Mansoura University Emergency Hospital (ICU units). Each hospital serves a wide range of young patient's ages from one day up to 16 years old. All nurses who were involved in paediatric postoperative pain management were subjected to a specific questionnaire which assess different items that may affect the postoperative pain management practice. Results: Forty-seven participants have completed this study. The availability of pain assessment tool, level of knowledge, pain assessment, use comfort measures and considering pain management as a major priority were higher among the studied nursing staff. Meanwhile, participants who paid more attention for pain assessment and recording were lower. Good pain management practice was higher in female, married participants and among bachelor's, technical institute of nursing graduates and secondary nursing school graduated staff. The availability of pain assessment tool, morphine stock, knowledge, pain assessment, management and handover were associated with higher good pain practice among the studied nurse group. Conclusion: Nursing graduation level, marital status, knowledge, training and familiarity with pain assessment, and management tools, effective communication and pain management handover are fundamental factors that significantly improve the paediatric postoperative pain services.
Background:
In neonates, percutaneous central venous catheter (CVC) insertion is often a challenging technique. Recent reports have reported the efficacy of ultrasound (US) guidance when performing such an intervention. We conducted this study to compare US-guided and minimal surgical CVC insertion regarding time and ease of insertion, reliability, and complications.
Patients and Methods:
This prospective randomized study included 92 neonates scheduled for CVC insertion. They were divided into two groups: Group A (46 neonates) underwent the US-guided approach and Group B (46 neonates) underwent the surgical approach. The number of attempts and the duration of the procedure were documented in both groups. In addition, intraoperative and postoperative complications were recorded.
Results:
Each of patient's age, gender, weight, and the indication of catheter insertion were statistically comparable between the two groups. The number of trials showed a significant increase in Group A (1.52 vs. 1.07 in Group Bp <0.001). Nevertheless, the time of the procedure was significantly decreased in the same group (3.68 vs. 10.21 in Group Bp <0.001).
Table 2
summarizes the previous findings. Failure was encountered only in one case in Group A (2.2%), which was converted to the open surgical technique. In general, the incidence of complications showed no significant difference between the two approaches.
Conclusion:
Although US-guided CVC insertion is associated with an increased number of trials, the duration of the procedure is significantly diminished with its use. Furthermore, it has a high success rate in addition to a comparable complication profile with the traditional surgical method.
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