Background: The quadratus lumborum (QL) block, also known as the abdominal truncal block, was developed to provide visceral and somatic analgesia during abdominal procedures. Objectives: This study aimed to assess pain alleviation, the incidence of complications in lower abdominal procedures, and hemodynamic stability between the caudal block and ultrasound-guided QL block. Methods: Fifty-two patients aged 1 to 7 years old from both genders scheduled for unilateral lower abdominal surgery were randomly assigned to 2 study groups: group QL, unilateral QL block (n = 26), and group C, caudal block (n = 26). In group C, children received caudal block. In group QL, an ultrasound-guided QL block was performed. The time to first rescue analgesia was evaluated as a primary outcome. The quality of analgesia was determined using the face, legs, activity, cry, consolability scale (FLACC scale), hemodynamic parameters, and incidence of complications because hemodynamic instability was recorded under ultrasound guidance. Signs of local anesthetics toxicity and the parents’ satisfaction were secondary outcomes. Results: The time until the first demand for analgesia postoperatively was statistically longer in group QL compared to group C. A non-significant difference was observed between the 2 groups (P > 0.05) regarding age, weight, gender, duration of surgery, type of surgery, FLACC scale, and hemodynamics (SBP, systolic blood pressure), except at 30 minutes, which was significant in QL block. Also, a non-significant difference was observed in the severity of postoperative pain up to 1 day postoperatively. Group QL showed more satisfaction than group C. No intraoperative complications were detected. Conclusions: Compared to caudal block, QL block produced sustained and adequate analgesia time postoperatively, with higher satisfaction.
Background: Enhancing gastric emptying would allow more liberal preoperative fasting guidelines in children. We evaluated the impact of semi-sitting position on gastric emptying of clear fluids compared to regular supine position in children. Methods: A randomized controlled trial included 30 fasting children aged between 4 and 16 years old. Gastric ultrasound was performed to evaluate the antral cross sectional area. Baseline measurements were obtained. After receiving oral apple juice (200 mL), participants were randomized into either supine group (n = 20) or semi-sitting group (n = 10). Serial ultrasound measurements of the antral cross sectional area were conducted every 30 min till complete evacuation of the stomach. The primary outcome was the number of children whom stomach returned to the baseline measurement (denoting complete gastric emptying) after 30 min. Other outcomes included antral cross sectional area and hunger satiety score. Results: After 30 min of fluid ingestion, 40% of the semi-sitting group showed complete gastric emptying; whilst, none of the children in the supine group showed complete gastric emptying after the same period (P = 0.008). Hunger satiety score increased in both groups after fluid ingestion; however, the duration of high hunger satiety score was shorter in the semi-sitting group. Conclusion: Semi-sitting position enhances gastric emptying of clear fluids in fasting children compared to supine position.
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