Please confirm that an ethics committee approval has been applied for or granted: Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submission

Background and Aims Lateral quadratus lumborum blocks (LQLB) provide good analgesia for lower abdominal procedures by targeting somatic and visceral nerves whilst avoiding complications associated with neuraxial blockade (1,2,3). Despite this, caudal epidural blockade (CEB) remains a commonly practiced paediatric technique despite potential significant complications. This review aims to assess if LQLBs are a suitable alternative to CEB, Ilioinguinal- hypogastric nerve block (II-IHNB) and transverse abdominus plane blocks (TAPB) for paediatric patients undergoing unilateral day-case orchidopexy surgery.

Methods A retrospective case notes review was performed of all patients undergoing elective unilateral day-case orchidopexy surgery between January and September 2022 at a tertiary paediatric hospital. Parameters recorded included length of stay, anaesthetic technique and peri-operative analgesic medications.

Results Ninety-eight patients met the inclusion criteria. Predominant regional techniques included CEB (21%, 21), LQLB (28%, 27), TAPB (18%, 18), II-IHNB (12%, 12) and local infiltration (LI) (16%, 16). CEBs experienced a complication rate of 24% (5) compared to other regional techniques which did not have any. LQLB, TAPB, and LI were statistically safer procedures. Post operative opioids were required in 14% (3), 22% (6), 50% (6), 31% (5) and 22% (4) for those receiving CEB, LQLB, II-IHNB, TAPB and LI respectively. The difference between CEB and II-IHNB was statistically significant (p=0.044 Fishers Exact Test).

Conclusions Our data suggests that LQLBs provide similar post-operative analgesia compared to CEB but with a significantly lower complication rate. We suggest therefore that LQLBs are non-inferior to CEBs although further research is required to compare clinical profiles further.

Attachment Local research and audit approval – QL project Alder Hey.pdf