Shahar Rotem 1 Israel A Ostrovsky 2 Galya Raisin 1 Stanislav Kocherov 1 Jawdat Gaber 1 Alexander Zeldin 2 Yaacov Gozal 2 Boris Chertin 1 Departments of Pediatric Urology ID: 910235
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Slide1
Is Ultrasound-guided Single Shot Quadratus Lumborum Block (QLB) a Viable Alternative To Caudal Block (CB) in Pediatric Urological Surgery?
Shahar Rotem1, Israel A. Ostrovsky2, Galya Raisin1, Stanislav Kocherov1, Jawdat Gaber1, Alexander Zeldin2, Yaacov Gozal2, Boris Chertin1Departments of Pediatric Urology1 and Anesthesiology2, Shaare Zedek Medical Center, Faculty of Medical Science, Hebrew University, Jerusalem, Israel
Slide2Objectives
Caudal anesthesia(CB) is considered the ‘‘gold standard’ ’for postoperative pain relief after numerous pediatric urological procedures although has side effects such as urinary retention and leg weakness.Quadratus Lumborum Block(QLB) demonstrated a spread to the paravertebral space, thus leading to a more extensive and long lasting block, with the potential to provide visceral pain relief. Benefits of QLB in pediatric population yet to be proved.
Slide3AIM We aimed to review the efficacy and safety of ultrasound-guided QLB in pediatric urology surgery in comparison to CB.
Slide4Material and MethodsN=41
The time of analgesia, surgery and hospitalization were recorded. Postoperative pain score was evaluated by Face Legs Activity Cry Consolability scale (FLACC) up to the age of 3 years old and Wong-Baker Faces (WBF) scale for those who were older. Overall use of rescue analgesics was calculated.Time and number of doses of postoperative analgesia were recorded over 24 hours. The results were compared with matched cohort of patients who underwent similar surgeries with CB
Slide5The results were compared with matched cohort of patients who underwent similar surgeries utilizing Caudal Block (CB) from our retrospectively acquired data registry.
Slide6Results
The FLACC pain score and the WBF pain score were not significantly different between the groups p=0.8909 and p=0.8485 after 1 hour, p=0.8812 and p=0.85 after four and p=0.8911 and p=0.847 after 24 hour subsequently.
Slide7RESULTS
The time for first rescue analgesia was not different in both group (p=0.853).There was no difference in the postoperative opioid requirements were between two groups 0.016mg/kg in QLB compared to the 0.01 mg/kg in CB (p =0.18). Finally, no statistically differences were found in the use of rescue analgesics at home, pain record behavior and overall feedback from the treatment.
Slide8Conclusions
Our data show that QLB might serve as a viable alternative to CB in pediatric urological surgery. This is a safe technique, which showed no complications. Although pain scores of the patients did not show statistical significance, the patients from QLB required more non-opiate rescue analgesia during first 24 hours after surgery. Further randomized prospective studies are required in order to further evaluated a place of QLB in the surgical armamentarium.