Sinan YILMAZ, Deniz KARA, Shainaaz Su Sandar Lwin DOOPLY, Ayda TÜRKÖZ, Serdar YEŞİLTAŞ, Kazım KARAASLAN, Celal Bulut İPEK, Asım ESEN

Comparison of ultrasound-guided transversus abdominis plane block, quadratus lumborum block, and caudal epidural block for perioperative analgesia in pediatric lower abdominal surgery

Background/aim: Despite different regional anesthesia techniques used to provide intraoperative and postoperative analgesia inpediatric patients, the analgesic effectiveness of peripheral nerve blockades with minimal side effect profiles have not yet been fullydetermined.We aimed to compare the efficacy of ultrasound-guided transversus abdominis plane (TAP) block, quadratus lumborum (QL) block,and caudal epidural block on perioperative analgesia in pediatric patients aged between 6 months and 14 years who underwent electiveunilateral lower abdominal wall surgery.Materials and methods: Ninety-four patients classified under the American Society of Anesthesiologists physical status classificationsystem as ASA I or ASA II were randomly divided into 3 equal groups to perform TAP, QL or Caudal epidural block using 0.25% ofbupivacaine solution (0.5 ml kg−1).Results: Postoperative analgesic consumption was highest in the TAP block group (P < 0.05). In the QL block group, Pediatric ObjectivePain Scale (POAS) scores were statistically significantly lower after 2 and 4 h (P < 0.05). The length of hospital stay was significantlylonger in the caudal block group than the QL block group (P < 0.05).Conclusion: We suggest that analgesia with ultrasound-guided QL block should be considered as an option for perioperative analgesiain pediatric patients undergoing lower abdominal surgery if the expertise and equipment are available.

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1. Reinoso-Barbero F, Martinez-Garcia E, HernandezGancedo MC, Simon AM. The effect of epidural bupivacaine on maintenance requirements of sevoflurane evaluated by bispectral index in children. European Journal of Anaesthesiology2006;23:460-464. doi: 10.1017/ S0265021506000330
2. Kim SH, Chun D, Chang CH, Kim TW, Kim YM et al. Effect of caudal block on sevoflurane requirement for lower limb surgery in children with cerebral palsy. Paediatric Anaesthesia 2011; 21:394-8.doi: 10.1111/j.1460-9592.2011.03530.x
3. Samol NB, Furstein JS, Moore DL. Regional Anesthesia and Pain Management for the Pediatric Patient. International Anesthesiology Clinics 2012; 50:83-95. doi: 10.1097/ AIA.0b013e31826df81a
4. Lönnqvist PA. Blocks for pain management in children undergoing ambulatory surgery. Current Opinion in Anaesthesiology 2011; 24: 627-632. doi: 10.1097/ ACO.0b013e32834a276d
5. Tsui BC, Berde CB. Caudal analgesia and anesthesia techniques in children. Current Opinion in Anaesthesiology 2005;18:283- 8. doi: 10.1097/01.aco.0000169236.91185.5b
6. Koul A, Pant D, Sood J. Caudal Clonidine in Day-Care Paediatric Surgery. Indian Journal of Anaesthesia 2009; 53: 450-454.
7. Suresh S, Long J, Birmingham PK, De Oliveira GS Jr. Are Caudal Blocks for Pain Control Safe in Children? An Analysis of 18,650 Caudal Blocks from the Pediatric Regional Anesthesia Network (PRAN) Database. Anesthesia and Analgesia 2015; 120:151-156. doi: 10.1213/ANE.0000000000000446
8. Menzies R, Congreve K, Herodes V, Berg S, Mason D. A survey of pediatric caudal extradural anesthesia practice. Paediatric Anaesthesia 2009; 19: 829-836. doi: 10.1111/j.1460- 9592.2009.03116.x
9. Chin KJ, Chan V. Ultrasound-guided peripheral nerve blockade. Current Opinion in Anaesthesiology 2008; 21:624- 631. doi: 10.1097/ACO.0b013e32830815d1
10. Suresh S, Chan VWS. Ultrasound guided transverses abdominis plane block in infants, children and adolescents: a simple procedural guidance for their performance. Paediatric Anaesthesia 2009; 19:296-299. doi: 10.1111/j.1460- 9592.2009.02958.x
11. Blanco R. TAP block under ultrasound guidance: the description of a “non pops technique.” Regional Anesthesia and Pain Medicine 2007; 32:130.
12. Sahin L, Soydinc MH, Sen E. Comparison of 3 different regional block techniques in pediatric patients. Saudi Medical Journal 2017; Vol. 38 (9) 953-959. doi: 10.15537/smj.2017.9.20505
13. Bosenberg A. Benefits of regional anesthesia in children. Paediatric Anaesthesia 2012; 22: 10-18.
14. Willschke H, Kettner S. Pediatric regional anesthesia: abdominal wall blocks. Paediatric Anaesthesia 2012; 22:88-92. doi: 10.1111/j.1460-9592.2011.03704.x
15. Harsha S. A systematic review and meta-analysis of caudal block as compared to noncaudal regional techniques for inguinal surgeries in children. BioMed Research International Volume 2014 (2014), Article ID 890626.
16. Sethi N, Pant D, Dutta A, Koul A, Sood J et al. Comparison of caudal epidural block and ultrasonography-guided transversus abdominis plane block for pain relief in children undergoing lower abdominal surgery. Journal of Clinical Anesthesia. 2016; 33: 322-329. doi: 10.1213/01.ane.0000492664.21379.10
17. Elsharkawy H, El-Boghdadly K, Kolli S. Injectate spread following anterior sub-costal and posterior approaches to the quadratus lumborum block. European Journal of Anaesthesiology 2017; 34: 587-595. doi: 10.1097/ EJA.0000000000000680
18. Aksu C, Gurkan Y. Ultrasound guided quadratus lumborum block for postoperative analgesia in pediatric ambulatory inguinal hernia repair. Journal of Clinical Anesthesia 46 (2018) 77-78. doi:10.1016/j.jclinane.2018.02.002
19. Oksuz G, Bilal B, Gurkan Y. Quadratus Lumborum Block versus Transversus Abdominis Plane Block in Children Undergoing Low Abdominal Surgery: A Randomized Controlled Trial. Regional Anesthesia and Pain Medicine.2017; 5: 674-679. doi:10.1097/AAP.0000000000000645
20. Akerman M1, Pejčić N2, Veličković I. A review of the quadratus lumborum block and ERAS. Frontiers in Medicine (Lausanne). 2018; 26; 5: 44. doi:10.3389/fmed.2018.00044