Ultrasound Guided Quadratus Lumborum Block Compared to Caudal Bupivacaine/Neostigmine in Pediatric Lower Abdominal Surgeries: A Randomized Controlled Trial

Abstract

Abstract Background The postoperative analgesia in pediatric patients undergoing lower abdominal surgeries could be achieved by Quadratus lumborum block (QLB) or Caudal block (CB). The combination of neostigmine and bupivacaine shortens the onset and increases the duration of regional blocks. Methods 80 pediatric patients undergoing lower abdominal surgeries under general anesthesia were randomized to receive either QLB using bupivacaine or CB using bupivacaine/neostigmine mixture. Time to first needed rescue analgesia was considered as a primary outcome while pain score, blood glucose level, nausea, vomiting, bradycardia, hypotension and urinary pretension were considered as secondary outcomes. Results The time to first rescue of analgesia was significantly longer in QLB group (p=˂ 0.001) and rate of rescue analgesia requirements was significantly lower in quadratus lumborum group (p=˂ 0.001), while time to perform the block and block failure were significantly higher in QLB group. Side effects were infrequent and non-significant among groups. Conclusion Postoperative analgesia for pediatric patients undergoing lower abdominal surgeries could be safely and effectively achieved by Quadratus lumborum block and caudal bupivacaine/neostigmine mixture block with priority to caudal block.