Quadratus Lumborum Block Versus Transversus Abdominis Plane Block in Children Undergoing Laparoscopic Appendicectomy
Condition: Children; Appendicitis
MeSH terms: Appendicitis
Study type: Interventional

Summary: 
      QL block has been recently described for chronic pain following abdominal hernia repair, and
      for postoperative analgesia following abdominal surgery as it leads to complete pain relief
      in the dermatomal area from (T6 - L1). Theoretically, QL blocks might give better and
      longer-lasting analgesia compared to the US-guided anterior TAP block due to a spread to the
      thoracic paravertebral space and sympathetic nerves in the thoracolumbar fascia, so visceral
      afferent pathways to the medulla can be blocked.
    

Detailed description: 
      Recently, the laparoscopic technique has been successfully used for many pediatric surgical
      cases. The laparoscopic appendicectomy is favored over the traditional open method, as it has
      a lower incidence of postoperative surgical complications and faster recovery to normal daily
      activities. Although it is considered as minimally invasive surgery, patients may require
      hospitalization for over 24 hours following laparoscopic appendicectomy, and postoperative
      pain which is caused by the surgical wound and visceroperitonitic pain as a result of
      peritoneal inflammation and infection, may extend the length of hospital stay.

      Regional anesthesia techniques are commonly enhanced for pain management in pediatric
      surgical procedure as they decrease parenteral opioid requirements and improve patient-parent
      satisfaction [6].

      The Transversus Abdominis Plane (TAP) block was first described in 2004 by McDonnell et al.
      using anatomical landmark guidance, and ultrasound-guided technique was later popularized by
      Hebbard et al. TAP block is aiming to block sensory nerves that course between the
      transversus abdominis and internal oblique muscles and supply the anterior abdominal wall,
      where local anesthetic is injected into the transversus abdominis fascial plane. Many
      clinical studies have reported the efficacy of TAP block in providing adequate postoperative
      analgesia for lower abdominal surgery.

      Quadratus Lumborum block was initially described by R.Blanco as an abstract at the annual
      European Society of Regional Anaesthesia (ESRA) congress in 2007, where the local anesthetic
      (LA) was injected in the anterolateral aspect of the QL muscle (type 1 QL block). Later, J.
      Børglum used posterior transmuscular approach by detecting Shamrock sign and injecting the LA
      in the anterior aspect of the QL (type 3 QL block). Recently, R. Blanco described another
      approach by injecting the LA in the posterior aspect of the QL muscle (type 2 QL block),
      which may be easier and safer as the LA is injected in a more superficial plane, so the risk
      of intra-abdominal complications and lumbar plexus injuries is reduced. And finally the
      intramuscular QL block (type 4 QL block), the local anesthetic is injected directly into the
      QL muscle.

      We hypothesize that ultrasound-guided QL block will be more superior than or equal to TAP
      block in providing postoperative analgesia for children undergoing laparoscopic
      appendicectomy.
    

Intervention name(s): QLB; TAP block
Intervention type(s): Procedure; Procedure
Intervention description(s): QLB type 2 approach; classic TAP block approach
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: 34 patients randomly allocated into two equal groups 17 patients in each group: Quadratus Lumborum Block" QLB group": ultrasound-guided QLB type 2 with 0.5ml/kg of 0.25% levobupivacaine local anesthetic was done to patients.
and Transversus Abdominis Plane Block group (TAP block): ultrasound-guided TAP block with 0.5ml/kg of 0.25% levobupivacaine local anesthetic was done to patients.
Masking: Double (Participant, Care Provider)
Primary purpose: Supportive Care
Keywords: Pediatric; Quadratus Lumborum; regional anesthesia