Ultrasound-Guided Quadratus Lumborum Block Versus Caudal Block for Perioperative

Area of Science:

• Anesthesiology
• Pediatric Surgery
• Pain Management

Background:

• Quadratus lumborum block is an effective truncal block for postoperative pain relief.
• Open pyeloplasty in pediatric patients requires effective postoperative analgesia.
• Comparing regional anesthesia techniques is crucial for optimizing pediatric surgical care.

Purpose of the Study:

• To compare the analgesic efficacy of caudal block versus ultrasonography-guided quadratus lumborum block.
• To evaluate postoperative pain scores, analgesic consumption, and duration of analgesia.
• To assess the safety and effectiveness of these blocks in pediatric patients undergoing open pyeloplasty.

Main Methods:

• Fifty pediatric patients (≤ 16 kg, ≤ 4 years) undergoing open pyeloplasty were randomized into caudal block or transmuscular quadratus lumborum block groups.
• Postoperative pain scores, analgesic requirements (fentanyl, paracetamol), and vital signs were monitored.
• Statistical analysis was performed to compare outcomes between the two groups.

Main Results:

• The quadratus lumborum block group demonstrated a significantly longer duration of postoperative analgesia (11.27 ± 3.74 hr) compared to the caudal group (6.85 ± 1.99 hr) (P < .001).
• Postoperative paracetamol consumption was significantly lower in the quadratus lumborum block group (P = .005).
• Pain scores were significantly lower in the quadratus lumborum block group at multiple time points, with no significant difference in perioperative fentanyl use or hemodynamic parameters. No complications were reported.

Conclusions:

• Ultrasonography-guided quadratus lumborum block is more effective than caudal block for postoperative analgesia in pediatric patients undergoing open pyeloplasty.
• Quadratus lumborum block offers a longer duration of pain relief and reduced analgesic requirements.
• This technique presents a safe and effective alternative for managing postoperative pain in this patient population.