Abstract
Post-operative analgesic management is challenging in infants and opioids have been the standard of care. However, they are associated with adverse effects which may negatively impact infants. In this retrospective cohort study, we sought to explore the postoperative analgesic efficacy of quadratus lumborum (QL) block in the infant population undergoing dorsal lumbotomy pyeloplasty. Chart review of 34 infants (≤12 months) who underwent dorsal lumbotomy pyeloplasty between 2016–2020 was performed. Post-operative pain was assessed using externally validated pain scales (CRIES & FLACC) and monitored hemodynamics (pulse and blood pressure). Opioid doses were standardized by using morphine milligram equivalency (MME). The Prescription Database Monitoring Program (PDMP) was utilized to determine if discharge opioid prescriptions were filled. Of 34 patients, 13 received the QL block. Mean age at the time of surgery was 6.2 months ± 3.2 months. The QL group received 0.8 MME postoperatively, whereas the non-QL group received 0.9 MME (p = 0.82). The QL group (20%) filled their discharge opioid prescription less frequently compared to non-QL group (100%) (p = 0.002). There were no observed differences between pain scale or hemodynamic variables. Further studies are warranted to explore QL block’s efficacy for post-operative infant pain management.
Highlights
Non-steroidal anti-inflammatory drugs (NSAIDs) and opioids are the standard of care for breakthrough peri-operative pain management [3]
In the presence of a pediatric anesthesiologist, parents of patients were offered the option of quadratus lumborum (QL) block administration after discussing the pros and cons of the procedure
Our findings were contrary to previous studies that demonstrate the utility of QL block in post-operative pain management in pediatric patients
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Surgical correction of ureteropelvic junction (UPJ) obstruction is a gold standard treatment for symptomatic patients [1,2]. Postoperative pain management in pediatric patients can be challenging, especially in infants (≤12 months). Non-steroidal anti-inflammatory drugs (NSAIDs) and opioids are the standard of care for breakthrough peri-operative pain management [3]
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