Comparison of quadratus lumborum block and caudal block for postoperative analgesia in pediatric patients undergoing inguinal hernia repair and orchiopexy surgeries: a randomized controlled trial

Öksüz, Gözen; Arslan, Mahmut; Urfalıoğlu, Aykut; Güler, Ahmet Gökhan; Tekşen, Şeyma; Bilal, Bora; Öksüz, Hafize

doi:10.1136/rapm-2019-101027

Cited by 39 publications

(41 citation statements)

References 32 publications

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“…The rate of postoperative rescue analgesia is evaluated as the number of patients who required rescue analgesia in the first postoperative 24 hours. Six trials, with 302 patients total, reported the 24 hour rescue analgesia requirement (15)(16)(17)(19)(20)(21). QL block shows a significant reduction in the rate of postoperative rescue analgesia in the first 24 hours (RR = 0.41; 95% CI = 0.28 to 0.59; P < 0.001; Fig.…”

Section: The Rate Of Postoperative Rescue Analgesiamentioning

confidence: 99%

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Quadratus Lumborum Block is an Effective Postoperative Analgesic Technique in Pediatric Patients Undergoing Lower Abdominal Surgery: A Meta-Analysis

Zhao

et al. 2021

Pain Phys

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BACKGROUND: Quadratus lumborum (QL) block has shown promising analgesic efficacy in the adult population in previous meta-analyses. However, the response of the pediatric group to pain stimulation is stronger than that in the adult population, and the management of pediatric pain is constrained by limited available analgesia agents. All data analyzed during this study are collected from published articles. OBJECTIVE: The purpose of our systematic review was to evaluate whether QL block is also an effective postoperative analgesic technique, compared to other analgesic skills in pediatric patients undergoing lower abdominal surgery. STUDY DESIGN: A meta-analysis. METHODS: We identified randomized controlled trials (RCTs) from PubMed, Embase, the Cochrane Library, Web of Science, and Science Direct to compare QL block with other analgesic methods for relief of postoperative pain in pediatric patients undergoing lower abdominal surgeries under general anesthesia. The primary outcome was the rate of postoperative rescue analgesia; secondary outcomes include: pain scores at 30 minutes and 1, 2, 4, 6, 12, and 24 hours postoperatively, patient satisfaction, and block related complications. RESULTS: A total of 7 studies with 346 patients were included. QL block showed a significant reduction in the rate of postoperative rescue analgesia in the first 24 hours (RR = 0.41; 95% CI = 0.28 to 0.59; P < 0.001) compared to other analgesic techniques, without significant heterogeneity among the articles (I2 = 49%, P = 0.08). Compared with other analgesic methods, QL block significantly reduced the pain scores at 2 hours (Std.MD = -0.76; 95% CI = -1.16 to -0.35; P < 0.001) (I2 < 0.001%, P = 0.41), 4 hours (Std.MD = -0.34; 95% CI = -0.67 to -0.01; P = 0.04) (I2 < 0.001%, P = 0.53) and 12 hours postoperatively (Std.MD = -0.95; 95% CI = -1.44 to -0.47; P < 0.001) (I2 = 27%, P = 0.24). No significant differences were found between techniques at 30 minutes and 1, 6, or 24 hours postoperatively (P > 0.05). There was no statistically significant change in patient satisfaction (Std.MD = 0.49; 95% CI = -0.32 to 1.29; P = 0.24) or side effects (RD = -0.02; 95% CI = -0.06 to 0.02; P = 0.31) with QL block. LIMITATIONS: The major limitation of this meta-analysis is the relatively few RCTs and limited results included. Similarly, the differences in block approaches among the control groups (TAP, ESP, caudal block, opioid-based analgesia), drug types and concentrations, and multimodal analgesia programs led to considerable heterogeneity. Furthermore, some relevant outcomes were not investigated. CONCLUSION: Our systematic review and meta-analysis suggests QL block use for the pediatric population undergoing lower abdominal surgery, based on the current limited research evidence, as this method was an effective postoperative analgesic technique. KEY WORDS: Pediatric surgery, postoperative pain, quadratus lumborum block, side effects

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Section: The Rate Of Postoperative Rescue Analgesiamentioning

confidence: 99%

“…Main characteristics of the included trials. (15,16,20), 2 at 2 hours (15,20), 3 at 4 hours (15,18,20), 3 at 6 hours (15,16,20), 2 at 12 hours (15,20), and 3 at 24 hours (15,18,20). Data from the trial by Ipek (17) are not analyzed in the forest plot, as the data were presented as graphs rather than specific values.…”

Section: Postoperative Pain Scoresmentioning

confidence: 99%

Quadratus Lumborum Block is an Effective Postoperative Analgesic Technique in Pediatric Patients Undergoing Lower Abdominal Surgery: A Meta-Analysis

Zhao

et al. 2021

Pain Phys

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“…Caudal block provides postoperative analgesia as good as TAP block, and both of them provide better analgesia than ilioinguinal/iliohypogastric block according to prospective randomized single-blinded study by Sahin et al [22] Kendall et al reached the same conclusion in their systematic review of 40 randomized controlled trials in 2018 [21]. Therefore, recently published data suggest that QLB provides significantly more effective, and longer lasting analgesia than caudal block in pediatric patients undergoing inguinal hernia repair, orchidopexy, and ureteral reimplantation [10,12,16]. Also, patients with caudal blocks have significantly longer length of hospital stay [10].…”

Section: Discussionmentioning

confidence: 97%

“…Dr. Michaela Visoiu was the first one who used it for pain management following colon surgery in pediatric patient in 2013 [5]. QLB was used as a part of a multimodal pain management technique in pediatric patients that underwent nephrectomy [6], pyeloplasty [7], orchidopexy and, inguinal hernia repair [8][9][10][11][12], hip and femur surgery [13,14], extracorporeal shock wave lithotripsy [15], and surgery for vesicoureteral reflux [16].…”

Section: Discussionmentioning

confidence: 99%

Quadratus lumborum block in pediatric patients - a case series

Pejčić¹,

Mitic²,

Nikolić³

et al. 2021

Srp Arh Celok Lek

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Introduction. The quadratus lumborum block (QLB) was the first interfascial plane block introduced in Leskovac General Hospital thanks to the international teaching Kybele Inc. program in April 2017. Outline of cases. During the period from April 2017 to December 2019, 22 pediatric patients underwent various surgical procedures and had the QLB type 1 block as a part of a multimodal perioperative pain management plan. Unilateral QLB was provided for unilateral inguinal hernia repair, orchidopexy, testicular torsion repair, and open appendectomy. Bilateral QLB was provided for laparoscopic appendectomy and cholecystectomy. Decreased use of fentanyl and sevoflurane was noticed in the cases when QLB was performed preoperatively. All patients had well-controlled pain. Conclusion. QLB is a simple and safe technique. Clear sonographic landmarks allow it to be easily performed. QLB has great potential to improve and facilitate postoperative pain management.

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“…Pediatric nerve block is mostly performed under sedation or general anesthesia [21,22]. Sevo urane and propofol are currently commonly used for induction and maintenance of general anesthesia in children [23,24], but both of them have vasodilator effect.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Prediction Effect of Perfusion Index for Supraclavicular Brachial Plexus Block in Children

Wang

Deng

2021

Preprint

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Background: Pulse perfusion index (PI) is a reflection of blood perfusion. It has been reported that PI can be used to evaluate the effect of nerve block, but currently it is mostly focused on awake adults. In pediatric general anesthesia, it has been reported that PI can evaluate the effect of sacral block, but there is a lack of relevant research on the effect of brachial plexus blocks (BPB).Methods/Design: This is a mono-center, prospective, single-blinded, randomized controlled trial (RCT). 104 children aged 1 month to 12 years who undergo upper limb surgery will be enrolled in this study. According to anesthesia induction and maintenance medication, they will be divided into propofol group and sevoflurane group. Record the PI values of the index finger and little finger on the blocked and non-blocked sides of supraclavicular brachial plexus block (SCB) in all children. First, analyze the two groups of patients with complete blockage respectively, and observe whether the PI values of the index finger and the little finger have the same changes by comparing the baseline values. Secondly, the cases of failed or partial block will be analyzed to understand the relationship between the PI values of the index and little fingers. Thirdly, a comparative analysis of nerve block cases in the sevoflurane and propofol groups will find that PI in what kind of general anesthesia can better judge the effect of SCB in children. So as to provide a theoretical basis for PI to estimate the effect of SCB under general anesthesia in children.Discussion: After sevoflurane or propofol administration, changes in PI after BPB may exist in different situations at different periods. PI values in the blocked and non-blocked sides may vary with the metabolism of anesthetics. The surgery time is about 1h or so and the effects of nerve block still exist, so the PI value changes on the blocking side and the contralateral side can basically rule out the influence of general anesthetics on the PI value. Trial registration: ClinicalTrials.gov NCT04216823. Registered on 15 July, 2020.

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Comparison of quadratus lumborum block and caudal block for postoperative analgesia in pediatric patients undergoing inguinal hernia repair and orchiopexy surgeries: a randomized controlled trial

Cited by 39 publications

References 32 publications

Quadratus Lumborum Block is an Effective Postoperative Analgesic Technique in Pediatric Patients Undergoing Lower Abdominal Surgery: A Meta-Analysis

Quadratus Lumborum Block is an Effective Postoperative Analgesic Technique in Pediatric Patients Undergoing Lower Abdominal Surgery: A Meta-Analysis

Quadratus lumborum block in pediatric patients - a case series

Evaluation of Prediction Effect of Perfusion Index for Supraclavicular Brachial Plexus Block in Children

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