Eur J Pediatr Surg 2022; 32(03): 263-267
DOI: 10.1055/s-0040-1722223
Original Article

Is Ultrasound-Guided Single-Shot Quadratus Lumborum Block a Viable Alternative to a Caudal Block in Pediatric Urological Surgery?

Shahar Rotem
1   Department of Urology, Shaare Zedek Medical Center, Jerusalem, Israel
,
1   Department of Urology, Shaare Zedek Medical Center, Jerusalem, Israel
,
Israel A. Ostrovsky
2   Department of Anesthesiology, Shaare Zedek Medical Center, Jerusalem, Israel
,
Stanislav Kocherov
3   Department of Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Israel
,
Jawdat Jaber
3   Department of Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Israel
,
Alexander Zeldin
2   Department of Anesthesiology, Shaare Zedek Medical Center, Jerusalem, Israel
,
Elena Feldman
2   Department of Anesthesiology, Shaare Zedek Medical Center, Jerusalem, Israel
,
Yaacov Gozal
2   Department of Anesthesiology, Shaare Zedek Medical Center, Jerusalem, Israel
,
Boris Chertin
1   Department of Urology, Shaare Zedek Medical Center, Jerusalem, Israel
› Author Affiliations
Funding None.

Abstract

Objective To review our experience with quadratus lumborum block (QLB) in pediatric urology.

Materials and Methods This mixed prospective-retrospective study included 41 patients who received QLB following induction of general anesthesia. Data collected included: the duration of block induction, surgery, hospitalization, postoperative pain score, and the use of rescue analgesia. The results were compared with a matched cohort of patients who received caudal block (CB) during similar surgeries from our retrospectively acquired data registry.

Results There was no difference between the type and length of surgery, weight, sex, and age of the patients between the two groups. The duration of block induction was significantly shorter in the CB group compared with the QLB group (35.6 ± 14.6 vs. 239 ± 33.4 seconds [p < 0.0001]). There was no difference between the groups in pain scores at 1, 4, and 24 hours postoperatively, in the time to first rescue analgesia, or in the postoperative opioid requirements. However, the QLB group required more rescue analgesia compared with CB group (p = 0.016). Finally, no differences were found in the use of rescue analgesics at home, pain record behavior, and overall satisfaction.

Conclusion Our data show that QLB might serve as a viable alternative to CB in pediatric urological surgery.



Publication History

Received: 08 August 2020

Accepted: 25 November 2020

Article published online:
10 January 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Bosenberg A. Benefits of regional anesthesia in children. Paediatr Anaesth 2012; 22 (01) 10-18
  • 2 Chertin B, Zeldin A, Kocherov S, Ioscovich A, Ostrovsky IA, Gozal Y. Use of caudal analgesia supplemented with low dose of morphine in children who undergo renal surgery. Curr Urol 2016; 9 (03) 132-137
  • 3 Raux O, Dadure C, Carr J. et al. Principles of clincial anaesthesia paediatric caudal anaesthesia. Updat Anaesth 2010; (26) 32-36
  • 4 Blanco R. Tap block under ultrasound guidance: the description of a “no pops” technique. Reg Anesth Pain Med 2007; 32 (Suppl. 01) 130
  • 5 Kadam VR. Ultrasound-guided quadratus lumborum block as a postoperative analgesic technique for laparotomy. J Anaesthesiol Clin Pharmacol 2013; 29 (04) 550-552
  • 6 Ueshima H, Otake H, Lin JA. Ultrasound-guided quadratus lumborum block: an updated review of anatomy and techniques. BioMed Res Int 2017; 2017: 2752876
  • 7 Murouchi T. Quadratus lumborum block intramuscular approach for pediatric surgery. Acta Anaesthesiol Taiwan 2016; 54 (04) 135-136
  • 8 Baidya DK, Maitra S, Arora MK, Agarwal A. Quadratus lumborum block: an effective method of perioperative analgesia in children undergoing pyeloplasty. J Clin Anesth 2015; 27 (08) 694-696
  • 9 Kocherov S, Hen Y, Jaworowski S. et al. Medical clowns reduce pre-operative anxiety, post-operative pain and medical costs in children undergoing outpatient penile surgery: a randomised controlled trial. J Paediatr Child Health 2016; 52 (09) 877-881
  • 10 Öksüz G, Arslan M, Urfalıoğlu A. et al. 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. Reg Anesth Pain Med 2020; 45 (03) 187-191
  • 11 Akerman M, Pejčić N, Veličković I. A review of the quadratus lumborum block and ERAS. Front Med (Lausanne) 2018; 5: 44
  • 12 Boretsky KR. Regional anesthesia in pediatrics: marching forward. Curr Opin Anaesthesiol 2014; 27 (05) 556-560
  • 13 Chin KJ, McDonnell JG, Carvalho B, Sharkey A, Pawa A, Gadsden J. Essentials of our current understanding: abdominal wall blocks. Reg Anesth Pain Med 2017; 42 (02) 133-183
  • 14 Zorrilla-Vaca A, Li J. Dexamethasone injected perineurally is more effective than administered intravenously for peripheral nerve blocks: a meta-analysis of randomized controlled trials. Clin J Pain 2018; 34 (03) 276-284
  • 15 Ishio J, Komasawa N, Kido H, Minami T. Evaluation of ultrasound-guided posterior quadratus lumborum block for postoperative analgesia after laparoscopic gynecologic surgery. J Clin Anesth 2017; 41: 1-4