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Abstract
Background and Aims Background: Changing concepts have made pediatric pain management providers think beyond traditional opioid management to help alleviate pediatric pain1. Ultrasound-guided quadratus lumborum (QL) block is now considered as one of the novel abdominal block2.
Aims: To compare the post-operative analgesic effect between the three approaches of USG guided quadratus lumborum block (QLB).
Methods It’s a prospective, double-blinded, randomized trial of pediatric patients. 30 were recruited and randomized into 3 groups,
Group A, Trans-muscular/anterior QLB, Group B, Lateral QLB, Group C, Posterior QLB
After general anaesthesia, QLB was given with 0.2% ropivacaine, 0.5 ml/kg. Primary outcome – total fentanyl consumption in the first 24 hours of post-operative period. Pain in post-operative period was accessed using FLACC score3.
Results All baseline demographics were comparable. Total fentanyl consumption in the first 24 hours of post-operative period was statistically insignificant. But FLACC score at 30min in post-operative period was significant for Group C (mean – 5.2 ± 1.6, p – 0.035) in comparison to Group A (7.2 ± 1.9) and Group B (6.3 ± 1.2). FLACC score for 24 hours, remained less for Group C, it was statistically insignificant but could be clinically significant.
Even parental satisfaction score was statistically significant for Group C (p = 0.016).
Conclusions No dose of rescue analgesia was required in Group C (Group A – 2/10, Group B – 1/10). It was statistically insignificant but could be clinically significant. Hence USG guided posterior QLB has much better post – operative analgesic effect, without any complications.
IEC clearance was obtained with a letter reference number: AIIMS/Pat/IEC/PGTh/Jan19/15.