Quadratus lumborum blocks for abdominal transplant surgeries at UPMC Children's Hospital of Pittsburgh—A five year experience

Abstract

Background: Adequate perioperative analgesia for pediatric abdominal transplant surgery is essential for patient recovery. However, the risks of commonly used medications such as hepatotoxicity, nephrotoxicity, bleeding concerns, and poor graft results with opioids limit pain management in this population. Thoracic epidural, continuous erector spinae plane, and type-1 quadratus lumborum blocks (QLBs) have been described and utilized in the adult population in this setting. The safety and benefits of regional anesthetic techniques in pediatrics have been widely documented for different types of procedures except pediatric abdominal transplantation, where data remains scarce. Our primary goal was to determine if QLBs provided adequate perioperative analgesia when part of a multimodal approach. Secondary objectives were to examine complications and effects on the intensive care unit (ICU) and hospital stay. Methods:We performed a retrospective, observational study of pediatric patients who underwent abdominal transplant surgeries at the

Regional anesthesia for transplantation surgery ‐ A White Paper Part 2: Abdominal transplantation surgery

“…These benefits appear to apply to both laparoscopic approaches as well as open approaches 50 . The use of QL blocks has also been demonstrated in pediatric patients undergoing renal transplantation, although this study of 32 patients did not include a control group for comparison 26 …”

“…These authors concluded that QL blocks are feasible in this patient population and can be used as an effective part of a postoperative pain regime. Further, these patients had a low complication rate, with the only noted complication of one hematoma in a kidney transplant recipient 26 . Further investigation into QL and RS blocks is required before this task force can recommend either in liver transplantation surgery, though the task force acknowledges both are likely safe and effective in treating postoperative liver transplantation pain.…”

“…50 The use of QL blocks has also been demonstrated in pediatric patients undergoing renal transplantation, although this study of 32 patients did not include a control group for comparison. 26…”