Preliminary Experience With Quadratus Lumborum Catheters for Postoperative Pain Management in Pediatric-Aged Patients With Contraindications to Epidural Anesthesia

Abstract

Background: Although neuraxial techniques such as caudal and epidural anesthesia were initially the predominant regional anesthetic technique used to provide postoperative analgesia in children, there has been a transition to the use of peripheral nerve blockade such as the quadratus lumborum block (QLB). We present preliminary experience with QL catheters for continuous postoperative analgesia in a cohort of pediatric patients following colorectal surgery.Methods: After institutional review board (IRB) approval, we retrospectively reviewed the records of patients who underwent major colorectal surgery and received QL catheters for postoperative analgesia. The postoperative pain control data consisted of QL catheter characteristics, anesthetic agents, adjuncts, pain scores, and opioid consumption during the postoperative period. Results:The study cohort included eight pediatric patients, ranging in age from 1 to 19 years (median age 11.8 years). The QL catheters were placed in the operating room after the induction of anesthesia. Comorbid conditions in the cohort that were contraindications to neuraxial anesthesia included spinal/vertebral malformations, presence of a ventriculoperitoneal (VP) shunt, anal atresia, tracheo-esophageal fistula (VACTERL) association, and coagulation disturbances. All patients underwent complex colorectal or genito-urologic procedures. Bilateral QL catheters were placed in six patients, and unilateral catheters were placed in two patients. Four patients received 0.5% ropiva-caine and four patients received 0.2% ropivacaine of an initial bolus. The local anesthetic used for continuous infusion was 0.2% ropivacaine in five patients, 0.1% ropivacaine in two patients, and 1.5% chloroprocaine in one patient, with a median infusion rate of 0.11 mL/kg/h. QL catheter infusions were supplemented with intravenous opioids delivered by patient-controlled or nurse-controlled analgesia. The median opioid requirements in oral morphine milligram equivalents (MME) were 1.2, 1.0, 1.1, 0.5, and 0.6 MME/kg on postoperative days 1 -5. Daily median pain scores were ≤ 2 during the 5-day postoperative course. All catheters functioned successfully and were in place for a median of 79.3 h. Other than early inadvertent removal of two catheters, no adverse effects were noted.Conclusions: Although our preliminary data suggest the efficacy of QL catheters in providing prolonged postoperative analgesia for up to 3 -5 days following colorectal procedures, attention needs to be directed at measures to ensure that the catheter is secured to avoid inadvertent removal.

Establishment of an animal model of sciatic nerve injury induced by local anesthetics

“…Ropivacaine hydrochloride is the most widely used local anesthetic for nerve block in the clinic at present, and the concentration used in the clinic varies from 0.1 to 1%. [18][19][20] Because the sciatic nerve of C57BL/6 mice is thinner than the peripheral nerve of humans and direct incision injection is more intuitive than puncture injection, it is not easy to cause mechanical damage to the peripheral nerve. A previous study found that local anesthetics cause significant neurotoxic damage to developing neurons, and the concentration and exposure time of local anesthetics are important factors for nerve damage.…”

Paediatric pain management: from regional to virtual

“…Catheter placement can be unilateral or bilateral depending on indication, and would also serve to avoid some of the potential complications associated with instrumentation of the neuraxial space. Preliminary data suggest that quadratus lumborum catheters provide prolonged analgesia following colorectal procedures with no adverse effects noted other than early inadvertent catheter removal [13 ▪ ]. There are also promising data regarding decreased opioid consumption for adult patients undergoing bone marrow biopsies who receive quadratus lumborum blocks [14 ▪ ].…”