Application of the Quadratus Lumborum Block in Pediatric Gastrointestinal Surgery: A Scoping Review

Effective pain control is critical in pediatric gastrointestinal surgery to support recovery and improve postoperative outcomes. Regional anesthetic techniques have gained increasing interest, with the quadratus lumborum block (QLB) emerging as a promising option. As its use expands, this scoping review aimed to map the available evidence on QLB in pediatric gastrointestinal surgery. Specifically, it examined its application, gastrointestinal procedures involved, reported outcomes, and potential advantages and disadvantages.

This scoping review followed PRISMA-ScR guidelines and a published protocol with four predefined research questions. The PCC framework was used to define the review scope: Population, pediatric patients; Concept, QLB; Context, gastrointestinal surgery. A systematic search was performed in PubMed, Embase, and Cochrane CENTRAL. Studies investigating QLB in pediatric gastrointestinal surgery were included. Two reviewers independently conducted screening and data extraction.

Twenty-nine studies were included. QLB was predominantly performed using the posterior approach (55%). The administered anesthetic dose varied from 0.3 to 1 mL/kg. No studies measured the plasma concentrations of local anesthetics or assessed dermatomal coverage. The block was applied across various gastrointestinal procedures, most frequently inguinal hernia repair (76%). Outcomes from different abdominal surgeries were often reported in aggregate (59%). Postoperative pain was the primary outcome, evaluated using six different measures, with variability in pain scales, analgesic protocols, and rescue analgesia thresholds. Pain scores were the most common measure, assessed most often using the Face, Legs, Activity, Cry, Consolability scale (76%). Few studies compared different QLB approaches (10%). QLB offered superior or comparable analgesia compared to other techniques.

QLB appears effective for pediatric gastrointestinal surgery. However, the literature reveals considerable heterogeneity in outcome measures and study designs. Knowledge gaps remain regarding dose-related safety, dermatomal coverage, optimal dosing, and comparative efficacy of QLB approaches and gastrointestinal procedure-specific effectiveness. These findings may guide future research to optimize QLB use.