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Background and Aims Tumors of the gynecological system are rare in childhood and adolescence, and malignant tumors are even rarer. However, mixed mesodermal tumors such as dysgerminoma and teratoma are much more common in children than in adults. Children are more reluctant to pain after major laparotomy.

Methods We present a 14-year-old girl with a giant dysgerminoma. The clinical examination and laboratory tests revealed a pelvic tumor (26X18X12) and elevated cancer markers that both suggest malignancy. At the same time, swollen intraperitoneal lymph nodes and a large ascites collection are found without, however, the existence of metastases in other organs. After an oncological meeting, surgical excision of the tumor was decided and the histopathological study revealed stage T1C3 dysgerminoma. In the operation room, the girl received general anesthesia, and before awakening, a bilateral quadratus lumborum block was performed under ultrasound guidance. Post-operative pain assessment with the NRS scale, showed a satisfactory level of analgesia even 20 hours after the block thanks to the use of dexamethasone and without the use of additional analgesic agents. One week later, the patient was transferred to the Pediatric Oncology Clinic for further treatment.

Conclusions Ultrasound-guided quadratus lumborum block provides children, as well as adults, prolonged post-operative analgesia and reduced use of adjuvant analgesics without clinical side effects.

Attachment Quadratus lumborum block.docx