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Research and Opinion in Anesthesia & Intensive Care 7:167–175
Published by Wolters Kluwer - Medknow
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Context
Ultrasound (US)-guided quadratus lumborum block (QLB) is a new abdominal
truncal block used for perioperative pain management of both upper and lower
abdominal surgeries.
Aims
To compare the analgesic efficacy of US-guided QLB with transversus abdominis
plane (TAP) block.
Settings
Approval of Zagazig Institutional Review Board (IRB) was obtained (ZU-IRB # 5504/
16-9-2018) before the study, and patient’s informed written consent was also
obtained. Our clinical study was registered with ClinicalTrials.gov
(NCT04031196). A total of 34 pediatric patients scheduled for elective
laparoscopic appendectomy were randomly allocated in two equal groups: QLB
and TAP block groups.
Patients and methods
All patients received general anesthesia using intravenous 2 mg/kg propofol, 1 μg/
kg fentanyl, and atracurium 0.5 mg/kg. After induction of anesthesia, QLB group
received bilateral US-guided QLB type 2, using 0.5 ml/kg of 0.25% levobupivacaine,
whereas TAP block group received bilateral US-guided TAP block using 0.5 ml/kg
of 0.25% levobupivacaine. The primary outcomes were changes of intraoperative
hemodynamics and postoperative pain assessment. Secondary outcomes were
total intraoperative fentanyl consumption, the first time of rescue analgesics, total
rescue analgesic consumption in the first postoperative 24 h, and degree of parent
satisfaction.
Results
QLB group had statistically significant lower hemodynamic changes 15 min after
performing the block to the end of surgery (P<0.05), highly significant lower visual
analog scale score in the first postoperative 4 h (P<0.001), highly significant lower
intraoperative fentanyl dose (P<0.001), significant longer time for the first rescue
analgesic, lower analgesic doses given in the first 24 h postoperatively (P<0.001),
and higher parent satisfaction compared with TAP block group.
Conclusion
This study revealed that QLB provides longer and more effective postoperative
analgesia compared with TAP block in pediatric patients undergoing laparoscopic
appendectomy.
Keywords:
appendectomy, laparoscopic, pediatric, quadratus lumborum block, regional anesthesia,
transversus abdominis plane
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