Comparison between Ultrasound Guided Quadratus Lumborum Block and Caudal Block in Children Undergoing Lower Abdominal Surgeries

Abstract

Abstract Background Caudal epidural anesthesia is a widely used popular technique for postoperative analgesia. The caudal approach of the epidural space is done through the sacral hiatus. A success rate of 96% was reported, however it can cause complications such as needle trauma, infection, hematoma, inadvertent subarachnoid or intravascular injection of local anesthetic. Quadratus lumborum block (QLB) was found to be an effective method for postoperative analgesia in lower abdominal surgeries. The quadratus lumborum block is also known as the abdominal truncal block. Ultrasound-guided quadratus lumborum block is a technique that was developed to provide visceral and somatic analgesia during abdominal procedures, and it can provide perioperative analgesia for all age groups, including pediatric patients undergoing abdominal surgery. Aim of the Work The aim of this study was to compare the postoperative analgesic efficacies of QLB and the caudal block in pediatric patients undergoing lower abdominal surgeries under general anesthesia. Patients and Methods This prospective randomized controlled double-blind study was carried out on eighty patients between 6-12 years old and undergoing lower abdominal surgeries. Patients were equally categorized into two groups which are quadratus lumborum block group (40 patients) received general anesthesia followed by ultrasound- guided Quadratus Lumborum block (0.3 ml/Kg of 0.25% Bupivacaine) and caudal block group (40 patients) received general anesthesia followed by caudal block (0.5 ml/Kg of 0.25% Bupivacaine). Results VAS score measurements showed no statistically significant difference at baseline, after 1 hr, 18h and 24h postoperative, while VAS score measurements were significantly lower in QLB group than Caudal block group after 2h, 4h, 6h and 12h postoperative. Intraoperative HR and MAP measurements were insignificantly different between both groups. Postoperative HR and MAP measurements were insignificantly different at baseline, after 18h and 24h. Postoperative HR2 measurements were significantly lower in QLB group than Caudal block group after 1h, 2h, 4h, 6h, 12h, 18h and 24h. Time to first analgesic request was significantly higher in QLB group than caudal block group. Total paracetamol consumption was significantly lower in QLB group than caudal block group. Hospital stay was insignificantly different between both groups, also hypotension was reported to be significantly lower in QLB group than caudal block group. There were few cases that experienced postoperative nausea and vomiting in both groups but there was no statistically significant difference in PONV between the two groups. Conclusion Performing QLB (anterior approach) is recommended for pediatric analgesia in lower abdominal surgeries as it is more effective in decreasing total paracetamol consumption, pain scores, and prolonging postoperative analgesia time more than caudal block.