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A Prospective, randomized comparative study between ultrasound‐guided posterior quadratus lumborum block and ultrasound‐guided ilioinguinal/iliohypogastric nerve block for pediatric inguinal herniotomy
Author(s) -
Samerchua Artid,
Leurcharusmee Prangmalee,
Panichpichate Kachain,
Bunchungmongkol Nutchanart,
Wanvoharn Mullika,
Tepmalai Kanokkan,
Khorana Jiraporn,
Chantakhow Sireekarn
Publication year - 2020
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/pan.13837
Subject(s) - medicine , anesthesia , bupivacaine , nerve block , analgesic , surgery , fentanyl
Background Ilioinguinal/iliohypogastric nerve block is commonly performed to control postherniotomy pain. The posterior quadratus lumborum block has been recently described as an effective analgesic technique for pediatric low abdominal surgery. No data were found regarding the use of posterior quadratus lumborum block in comparison with the traditional ilioinguinal/iliohypogastric nerve block in pediatric inguinal surgery. Aim This randomized assessor‐blinded study compared postoperative analgesic effects between ultrasound‐guided posterior quadratus lumborum block and ilioinguinal/iliohypogastric nerve block in pediatric inguinal herniotomy. Methods One‐ to seven‐year‐old children scheduled for unilateral open herniotomy were randomly assigned to receive either ultrasound‐guided posterior quadratus lumborum block with 0.25% bupivacaine 0.5 mL/kg or ultrasound‐guided ilioinguinal/iliohypogastric nerve block with 0.25% bupivacaine 0.2 mL/kg after induction of general anesthesia. The primary outcome was the proportion of patients who received postoperative oral acetaminophen. The required fentanyl in the recovery room, 24‐hour acetaminophen consumption, success rate of regional blocks, block performance data, block‐related complications, postoperative pain intensity, and parental satisfaction were assessed. Results This study included 40 patients after excluding four cases who were ineligible. The number of patients who required postoperative oral acetaminophen was significantly lower in the posterior quadratus lumborum block group (15.8% vs 52.6%; OR: 5.9; 95% CI: 1.3, 27.3; P = .022). The pain scores at 30 minutes, 1, 2, 6, 12, and 24 hours were similar between groups. There was no evidence of between‐group differences in block performance time, the number of needle passes, block‐related complications, and parental satisfaction. Conclusion The posterior quadratus lumborum block with 0.25% bupivacaine 0.5 mL/kg provided better pain control than the ilioinguinal/iliohypogastric nerve block with 0.25% bupivacaine 0.2 mL/kg after open herniotomy in children. The ultrasound guidance technique for the posterior quadratus lumborum block is safe and as simple as the ultrasound‐guided ilioinguinal/iliohypogastric nerve block for pediatric patients.