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Abstract
Background and Aims Undescended testicle is a common genitourinary pathology in pediatric population. Due to the complex innervation of the testicle and spermatic cord, analgesic management can be challenging in orchiopexy. We aimed to compare the effects of transversus abdominis plane (TAP) and lateral quadratus lumborum block (QLB) on peri-postoperative pain, analgesic use and patient satisfaction in unilateral orchiopexy.
Methods This prospective, double-blind, randomized, controlled trial was approved by IRB of Istanbul University-Cerrahpasa (2019-71381), registered to Clinicaltrials.gov (NCT03969316) and enrolled 90 pediatric patients aged 6 months to 12 years. Lateral QLB or TAP block were applied under ultrasonography before the surgery. Our primary outcomes were the remifentanyl consumption during the surgery and pain intensity within 24 hours postoperatively. Postoperative pain was evaluated with FLACC score in hospital, Wong-Baker score after discharge. Additional postoperative analgesic consumption and parent satisfaction were evaluated.
Results As a primary outcome, the number of patients who needed remifentanyl was found significantly higher in the TAP group (p<0,001). FLACC and Wong-Baker scores, except the postoperative first hour FLACC score, were detected significantly higher in TAP group (p<0,001). Additional analgesic agent consumption at the 10th, 20th minutes, 6th, 16th and 24th hours, especially after the 6th hour, were significantly higher in the TAP group. Parent satisfaction was significantly higher in the QLB group (p<0.001).
Conclusions Preoperative lateral QLB is superior to TAP block in terms of peri-postoperative pain scores, additional analgesic requirement, patient satisfaction in orchiopexy, and it has been shown to be an appropriate option for the lower abdominal surgery in pediatric patients.