Bilateral erector spinae plane block vs quadratus lumborum block for pediatric postoperative pain management after laparoscopic abdominal surgery: a double blinded randomized study

Abstract

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

Postoperative analgesic effects of the quadratus lumborum block in pediatric patients: a systematic review and meta-analysis

“…All patients had American Society of Anesthesiologists (ASA) physical status scores of 1 or 2. In 10 [ 18 – 27 ] and two studies [ 28 , 29 ], patients underwent lower abdominal surgery, such as inguinal hernia repair or orchiopexy, and non-specified laparoscopic abdominal surgery; in two studies, patients underwent surgery for hip dysplasia [ 11 , 12 ], and in one study each, patients underwent open renal surgery [ 13 ] and bilateral ureteral reimplantation surgery [ 30 ]. Of the 16 studies, nine [ 18 , 20 , 22 – 25 , 28 – 30 ], three [ 21 , 26 , 27 ], and four studies [ 11 – 13 , 19 ] involved type 1, 2, and 3 QLB, respectively.…”

“…In 10 [ 18 – 27 ] and two studies [ 28 , 29 ], patients underwent lower abdominal surgery, such as inguinal hernia repair or orchiopexy, and non-specified laparoscopic abdominal surgery; in two studies, patients underwent surgery for hip dysplasia [ 11 , 12 ], and in one study each, patients underwent open renal surgery [ 13 ] and bilateral ureteral reimplantation surgery [ 30 ]. Of the 16 studies, nine [ 18 , 20 , 22 – 25 , 28 – 30 ], three [ 21 , 26 , 27 ], and four studies [ 11 – 13 , 19 ] involved type 1, 2, and 3 QLB, respectively. A wide range of control procedures were used: seven studies [ 13 , 21 – 23 , 26 , 29 , 30 ] used CB; four [ 22 , 24 , 25 , 29 ] used TAP; two each used transversalis fascia block (TFB) [ 11 , 18 ], erector spinae plane block (ESPB) [ 19 , 28 ], and ilioinguinal/iliohypogastric nerve block (II/IH) [ 25 , 27 ]; and one each used intravenous opioids [ 20 ] and incision-line injection [ 12 ].…”

“…Of the 16 studies, nine [ 18 , 20 , 22 – 25 , 28 – 30 ], three [ 21 , 26 , 27 ], and four studies [ 11 – 13 , 19 ] involved type 1, 2, and 3 QLB, respectively. A wide range of control procedures were used: seven studies [ 13 , 21 – 23 , 26 , 29 , 30 ] used CB; four [ 22 , 24 , 25 , 29 ] used TAP; two each used transversalis fascia block (TFB) [ 11 , 18 ], erector spinae plane block (ESPB) [ 19 , 28 ], and ilioinguinal/iliohypogastric nerve block (II/IH) [ 25 , 27 ]; and one each used intravenous opioids [ 20 ] and incision-line injection [ 12 ]. With regard to the type of local anesthetic, except for four studies [ 11 , 25 , 29 , 30 ] that used ropivacaine for QLB, all other studies used bupivacaine.…”

“…Data regarding the number of patients requiring rescue analgesia at 12 and 24 hours post-surgery are summarized in Table 2 . Four studies [ 18 , 20 , 24 , 25 ] and 12 studies [ 12 , 13 , 19 – 24 , 27 – 30 ] analyzed the necessity for rescue analgesia at 12 and 24 hours, respectively. QLB reduced the need for rescue analgesia at 12 hours (RR: 0.45; 95% CI: 0.01, 0.88; I 2 = 46.6%; P < 0.001; P h = 0.132; Fig.…”

“…The overall risk of bias was categorized as having “some concerns” in six studies [ 12 , 18 , 21 , 23 , 26 , 27 ] and “low” in ten studies [ 11 , 13 , 19 , 20 , 22 , 24 , 25 , 28 – 30 ], as indicated in Supplementary Figs. 8 and 9 .…”