The effects of abdominal nerve block techniques as preventive analgesia on pediatric laparoscopic procedures: A randomized controlled trial

Abstract

ABSTRACT Background The current study compared the effect of ultrasound-guided quadratus lumborum block (QLB) to transversus abdominis plane block (TAPB) on post-operative pain in children undergoing lower abdominal laparoscopy. Methods Ninety male and female patients (ASA I to II), ages (1–7), performing elective laparoscopic lower abdomen surgery randomly allocated into three equal groups of 30 patients each. Group (C) received conventional analgesics. In addition to conventional analgesics, 0.5 ml/kg of bupivacaine 0.25% was injected under US-guidance on both abdominal sides, into transversal plane at subcostal level in group (TAP) or into the facial plane between the PM and QL muscles in group (QL). Our primary outcome was the measuring FLACC scale immediately following surgery, every 30 minutes in the PACU, and then at 4, 6, 8, 10, 12, 18, and 24 hours after surgery. Our secondary outcomes were the first analgesic request, the dosage of analgesics, the postoperative complications, and parents’ satisfaction during the first 24 hours. Results When comparing the FLACC pain scores, the QL group showed a significant reduction in pain for the whole postoperative period in comparison to C group (p < 0.001) and up to 12 h in TAP group (p < 0.001). Patients in QL group got the longest time to the first analgesic requirement (p < 0.001). The C group required more analgesics overall than the other groups. Conclusions Ultrasound-guided QLB after induction of general anesthesia in comparison to TAP block provides better postoperative pain, prolonged analgesia, and less postoperative analgesic consumption after lower abdominal laparoscopic surgery in pediatrics.