الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 133 |  |  |
| | | from | 133 | | |
Abstract
This prospective, randomized, double-blinded controlled study was conducted at EL-Minia university hospital during the period from May 2019 to May2020. The study involved 90 patients of either sex, of ASA I and II physical status, aged (1-7) years old, and posted for elective laparoscopic lower abdominal surgery under general anesthesia.
The aim of the present study was to evaluate and compare the analgesic effect of ultrasound-guided Quadratus Lumborum Block with ultrasound-guided Transversus Abdominis plane block in pediatric Laparoscopic lower abdominal surgeries.
Patients were randomly divided into three equal groups; 30 patient in each group:
group C ”Control group” will receive regular analgesics (1 μg /kg fentanyl with induction and diclofenac sodium 1 mg/kg suppository before extubation).
group TAP ”TAP group” will receive bilateral TAP block using (0.5 ml/ kg bupivacaine 0.25%) in each side + regular analgesics.
group QL”quadratus lumborum group” will receive bilateral quadratus lumborum block using (0.5 ml/ kg bupivacaine 0.25%) in each side + regular analgesics.
All patients were assessed with regards to:
Hemodynamic parameters (HR, MAP) were recorded before and immediately after induction of anesthesia and then at 5, 10, 15, 20, 30 and 45 minutes, till the surgery ended, and for two hours after surgery.
Analgesic requirements: all through the procedure (by measuring the analgesic need intra operative in the form of fentanyl 0.5 μg/kg) and number of doses for each patient, and postoperatively for 24 hours by measuring pain score, analgesic requirement and analgesic consumption.
Incidence of complications: in the form of hemodynamic instability, injury to the underlying structures (injury to the liver or a viscus), and hematoma formation as recorded under ultrasound guidance.
The incidence of adverse effects whether related to the drugs used in the technique or related to the technique itself were recorded.
The results of this study found that demographic (age, sex, weight and ASA classification were statistically insignificant between the three groups.
Hemodynamics (HR and MAP) were increased significantly in the control group (C) more than other two groups (QL group andTAP group).
As regard duration of postoperative analgesia was clinically and significantly longer in QL group, mean = (18 hr) than TAP group, mean = (8hr) than control group mean = (1 hr).
The median values of pain score among the studied groups were significant with p value (<0.001). QL group Showed a better pain score values postoperatively except at 18 hour when FLACC was >4 with a median values of (5(4-5)). TAP group showed better pain score values postoperatively except at 8 hour and 20 hour when FLACC was > 4 with a median values of (5(4-5)) and (5(3-5)) respectively.
group C Showed higher levels in pain score with FLACC > 4 observed early in the postoperative period at 1 hour, 8 and 20 hours with a median value of (5(4-6)), (5(4-6)) and (5(4-5)) respectively.
The time to first analgesic request was significantly longer in QL group than(TAP group) than group (C)and subsequently the total analgesic requirements were higher in (C)than (TAP group) than (QL group).
While nausea and vomiting occurred in (3) patient in QL group (10%), (2) patients in TAP group (6.7%) and (1) patients in group C (3.3%) were complained, there was no statistically significant difference detected between the studied groups.
Other complications in the form of bradycardia and hypotension were not observed among studied groups.
We concluded that ultra sound guided Quadratus lumborum block provided longer and more effective postoperative analgesia compared with the transversus abdominis plane block. after laparoscopic lower abdominal surgery in pediatrics as it provides reduced pain score ,delayed analgesic request and less analgesic requirement .
Recommendation
Based on the current study:
1. Quadratus lumborum block is recommended as effective,safe and easy technique for post-operative analgesia in laparoscopic lower abdominal surgeries in pediatrics.
2. Further studies probably are required on a larger sample size to confirm our results.
3. Future studies may be needed to assess pain beyond 24 hours
4. Further studies on QL block and TAP block using adjuvants to local anesthetic in pediatrics.