Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Comparison of Postoperative Analgesic Efficacy Between Ultrasonography-Guided Quadratus Lumborum and Transversus Abdominis Plane Blocks in Infants Undergoing Inguinal Hernia Surgery: Randomized Controlled Trial
Kasık Fıtığı Ameliyatı Olan İnfantlarda Ultrasonografi Eşliğinde Yapılan Quadratus Lumborum Bloğu ve Transversus Abdominis Plan Bloğunun Postoperatif Analjezik Etkinliğinin Karşılaştırılması: Randomize Kontrollü Bir Çalışma
Pınar SAYINa, Hacer Şebnem TÜRKa, Mustafa ALTINAYa, Melis TÜRKEL ÖZKANa, Serkan İSLAMOĞLUa, Surhan ÇINARa
aClinic of Anesthesiology and Reanimation, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Türkiye
Turkiye Klinikleri J Med Sci. 2022;42(2):87-94
doi: 10.5336/medsci.2022-87968
Article Language: EN
Full Text
ABSTRACT
Objective: We compared the analgesic efficacy of ultrasonography (USG)-guided quadratus lumborum (QL) and transversus abdominis plane (TAP) blocks in infants undergoing elective unilateral inguinal hernia surgery (IHS). Material and Methods: This single-center, randomized, single-blind, 2-arm clinical trial included 60 infants undergoing elective IHS (aged 1 month to 1 year) with ASA I'II. The patients were randomized into QL block (Group A) and TAP block (Group B) groups. For both groups, 0.3 mL/kg of 0.25% bupivacaine was injected under USG guidance. Age, sex, weight, anesthesia duration (min), surgery duration (min), and recovery duration (min) were recorded. The heart rate (HR) was recorded at baseline, after anesthesia induction, and at 15 and 30 min after the blocks. Postoperatively, patients were evaluated based on their Face, Legs, Activity, Cry, and Consolability (FLACC) scores at 0, 1, 2, 6, 12, and 24 h. We also recorded the first analgesic duration, analgesic requirement, rescue analgesic requirement, and complications. The primary outcome of the study was FLACC score. Results: Sixty patients completed the study protocol. There were no significant differences between the groups in terms of age, sex, weight, anesthesia duration, surgery duration, recovery duration, or FLACC score or HR in the first 24 h postoperatively. The analgesic requirement, first analgesic requirement time, and rescue analgesic requirement were not significantly different between the groups (p>0.05 for all comparisons). Conclusions: QL and TAP blocks showed similar analgesic efficacy in infants undergoing IHS.

Keywords: Anesthesia, conduction; ultrasound; interventional; pediatric patients; quadratus lumborum; transversus abdominis plane block
ÖZET
Amaç: Bu çalışmada, elektif tek taraflı kasık fıtığı cerrahisi uygulanan infantlarda ultrasonografi (USG) kılavuzluğunda quadratus lumborum (QL) bloğu ve transversus abdominis plan (TAP) bloğunun analjezik etkinliğini karşılaştırmayı amaçladık. Gereç ve Yöntemler: Bu çalışma, ASA I-II durumu olan ve elektif kasık fıtığı cerrahisi uygulanan 60 infant hastanın (yaş aralığı 1 ay ila 1 yıl) dâhil edildiği tek merkezli, randomize, tek kör, 2 kollu klinik bir çalışmadır. Hastalar QL (Grup A) ve TAP blok (Grup B) gruplarına randomize edildi. Her iki gruba da USG eşliğinde %0,25 (0,3 mL/kg) bupivakain enjekte edildi. Yaş, cinsiyet, kilo, anestezi süresi (dk), ameliyat süresi (dk) ve derlenme süreleri (dk) kaydedildi. Kalp atım hızları (KH) bazal, anestezi sonrası, 15 ve 30. dk bloklar için kaydedildi. Ameliyat sonrası hastalar 0, 1, 2, 6. 12 ve 24. saatlerde Yüz, Bacaklar, Hareket, Ağlama, Avutabilme Davranışsal [Face, Legs, Activity, Cry, and Consolability (FLACC)] Skalası ile değerlendirildi. İlk analjezik ihtiyacı süresi, analjezik gereksinimleri, kurtarıcı analjezik gereksinimleri ve komplikasyonları kaydedildi. Çalışmanın birincil sonucu, FLACC skorlarının karşılaştırılması idi. Bulgular: Altmış hasta çalışma protokolünü tamamladı. Gruplar arasında yaş, cinsiyet, ağırlık, anestezi süresi, ameliyat süresi ve derlenme süresi ilk 24 saatteki FLACC skorları ve KH açısından anlamlı bir farklılık gözlenmedi. Analjezik gereksinimi, ilk analjezik gereksinimi ve kurtarma analjezik gereksinimleri gruplar arasında istatistiksel olarak anlamlı fark gözlenmedi (tüm karşılaştırmalar için p>0,05). Sonuç: Kasık fıtığı cerrahisi uygulanan infantlarda QL bloğu ve TAP bloğu benzer analjezik etkinlik gösterdi.

Anahtar Kelimeler: Anestezi; konduksiyon; ultrason; girişimsel; pediatrik hastalar; quadratus lumborum; transversus abdominis plan bloğu
REFERENCES:
  1. Öksüz G, Bilal B, Gürkan Y, Urfalioğlu A, Arslan M, Gişi G, et al. Quadratus lumborum block versus transversus abdominis plane block in children undergoing low abdominal surgery: a randomized controlled trial. Reg Anesth Pain Med. 2017;42(5):674-9. [Crossref]  [PubMed] 
  2. Anand KJ, Carr DB. The neuroanatomy, neurophysiology, and neurochemistry of pain, stress, and analgesia in newborns and children. Pediatr Clin North Am. 1989;36(4):795-822. [Crossref]  [PubMed] 
  3. Desai N, Chan E, El-Boghdadly K, Albrecht E. Caudal analgesia versus abdominal wall blocks for pediatric genitourinary surgery: systematic review and meta-analysis. Reg Anesth Pain Med. 2020;45(11):924-33. [Crossref]  [PubMed] 
  4. Boretsky KR. A review of regional anesthesia in infants. Paediatr Drugs. 2019;21(6):439-49. [Crossref]  [PubMed] 
  5. Monahan A, Deer J, Robles A, Traylor P. Regional anesthesia in babies and children. Int Anesthesiol Clin. 2019;57(4):e1-e23. [Crossref]  [PubMed] 
  6. Relland LM, Neel ML, Gehred A, Maitre NL. Regional anesthesia in neonates and infants outside the immediate perioperative period: a systematic review of studies with efficacy and safety considerations. Paediatr Anaesth. 2021;31(2):132-44. [Crossref]  [PubMed] 
  7. Ecoffey C, Lacroix F, Giaufré E, Orliaguet G, Courrèges P; Association des Anesthésistes Réanimateurs Pédiatriques d'Expression Française (ADARPEF). Epidemiology and morbidity of regional anesthesia in children: a follow-up one-year prospective survey of the French-Language Society of Paediatric Anaesthesiologists (ADARPEF). Paediatr Anaesth. 2010;20(12):1061-9. [Crossref]  [PubMed] 
  8. Zhao WL, Li SD, Wu B, Zhou ZF. Quadratus lumborum block is an effective postoperative analgesic technique in pediatric patients undergoing lower abdominal surgery: a meta-analysis. Pain Physician. 2021;24(5):E555-63. [Crossref]  [PubMed] 
  9. Walter CM, Abbasian N, Olbrecht VA. Trends in pediatric pain: thinking beyond opioids. Anesthesiol Clin. 2020;38(3):663-78. [Crossref]  [PubMed] 
  10. Öksüz G, Arslan M, Urfalıoğlu A, Güler AG, Tekşen Ş, Bilal B, et al. Comparison of quadratus lumborum block and caudal block for postoperative analgesia in pediatric patients undergoing inguinal hernia repair and orchiopexy surgeries: a randomized controlled trial. Reg Anesth Pain Med. 2020;45(3):187-91. [Crossref]  [PubMed] 
  11. Sola C, Menacé C, Bringuier S, Saour AC, Raux O, Mathieu O, et al. Transversus abdominal plane block in children: efficacy and safety: a randomized clinical study and pharmacokinetic profile. Anesth Analg. 2019;128(6):1234-41. [Crossref]  [PubMed] 
  12. Baeriswyl M, Zeiter F, Piubellini D, Kirkham KR, Albrecht E. The analgesic efficacy of transverse abdominis plane block versus epidural analgesia: a systematic review with meta-analysis. Medicine (Baltimore). 2018;97(26):e11261. [Crossref]  [PubMed]  [PMC] 
  13. İpek CB, Kara D, Yılmaz S, Yeşiltaş S, Esen A, Dooply SSSL, et al. Comparison of ultrasound-guided transversus abdominis plane block, quadratus lumborum block, and caudal epidural block for perioperative analgesia in pediatric lower abdominal surgery. Turk J Med Sci. 2019;49(5):1395-402. [Crossref]  [PubMed]  [PMC] 
  14. Aksu C, Şen MC, Akay MA, Baydemir C, Gürkan Y. Erector spinae plane block vs quadratus lumborum block for pediatric lower abdominal surgery: a double blinded, prospective, and randomized trial. J Clin Anesth. 2019;57:24-8. [Crossref]  [PubMed] 
  15. Falciola V, Boretsky K. Quadratus lumborum and rectus sheath blocks in an infant with severe pulmonary hypertension undergoing laparoscopic cholecystectomy. J Clin Anesth. 2020;64:109831. [Crossref]  [PubMed] 
  16. Tekin M, Gurkan Y, Solak M, Toker K. Ultrasound-guided bilateral transversus abdominis plane block in a 2-month-old infant. J Anesth. 2009;23(4):643-4. [Crossref]  [PubMed] 
  17. Kendigelen P, Tütüncü C, Ashyralyyeva G, Ozcan R, Emre S, Altindas F, et al. Transversus abdominis plane (TAP) block for postoperative analgesia in neonates and young infants: retrospective analysis of a case series. TAP blocks in neonates and young infants. Minerva Anestesiol. 2017;83(3):282 -7. [Crossref]  [PubMed] 
  18. Long JB, Birmingham PK, De Oliveira GS Jr, Schaldenbrand KM, Suresh S. Transversus abdominis plane block in children: a multicenter safety analysis of 1994 cases from the PRAN (Pediatric Regional Anesthesia Network) database. Anesth Analg. 2014;119(2):395-9. [Crossref]  [PubMed] 

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