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Background and Aims Multifidus muscle is one of the transversospinales muscles, a group of muscles extending from cervical spine to sacrum. Previous reports of local anesthetic injections into nearby interfascial sacral planes show effective long-term analgesia for anal and urogenital procedures for both adult and pediatric patients. We aimed to evaluate the efficacy of multifidus plan block on postoperative analgesia and opioid consumption in rectal biopsy in children. Our primary aim was to evaluate postoperative pain scores, and our secondary aims were to evaluate the first postoperative analgesic requirement, total analgesic requirement in the first 24 hours and side effects.

Methods A prospective, double-blind, randomized controlled study was conducted, including 40 patients aged between 0 and 2 years undergoing rectal biopsy.Group B patients will be placed in pron position and bilateral multifidus plan block will be performed with local anesthetic solution prepared with 1ml/kg bupivacaine at 0.25% concentration with ultrasound guidance using in-plane technique from cranial to caudal direction. Group C (control) regional block will not be performed.

Results Pain scores were significantly lower than control group all time points except 1, 18,24h. The time to first rescue analgesic was significantly longer and cumulative analgesic doses was lower in group B.

Conclusions During the rectal biopsy, tissues are excised from external anal sphincter for pathological examination. As this procedure is quite painful and is often performed in neonates and infants, regional analgesia may be desirable to reduce the need for opiates. We believe multifidus plane block can be an effective and safe block for these patients.

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