Department of Anesthesiology and Perioperative Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Division of Pediatric Transplantation, Department of Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States.
Pediatr Transplant. 2022 Aug;26(5):e14296. doi: 10.1111/petr.14296. Epub 2022 Apr 22.
Adequate perioperative analgesia for pediatric abdominal transplant surgery is essential for patient recovery. However, the risks of commonly used medications such as hepatotoxicity, nephrotoxicity, bleeding concerns, and poor graft results with opioids limit pain management in this population. Thoracic epidural, continuous erector spinae plane, and type-1 quadratus lumborum blocks (QLBs) have been described and utilized in the adult population in this setting. The safety and benefits of regional anesthetic techniques in pediatrics have been widely documented for different types of procedures except pediatric abdominal transplantation, where data remains scarce. Our primary goal was to determine if QLBs provided adequate perioperative analgesia when part of a multimodal approach. Secondary objectives were to examine complications and effects on the intensive care unit (ICU) and hospital stay.
We performed a retrospective, observational study of pediatric patients who underwent abdominal transplant surgeries at the University of Pittsburgh Medical Center Children's Hospital of Pittsburgh from January 2015 to July 2021 and received a single injection QLB for pain control. Data collected included: demographics, nerve block characteristics, perioperative opioid consumption, use of non-opioid analgesia, daily pain scores, and hospital and ICU stay.
Forty-two patients met the inclusion criteria for our study. Our results suggest that QLBs decrease opioid consumption, facilitate early extubation, prevent reintubation in the ICU, and reduce ICU and hospital stay.
QLB is feasible and can be used as a multimodal approach for postoperative pain control in pediatric solid organ transplantation.
小儿腹部移植手术需要充分的围手术期镇痛，这对患者的恢复至关重要。然而，由于常用药物（如阿片类药物的肝毒性、肾毒性、出血问题和移植物效果不佳）的风险，这种人群的疼痛管理受到限制。胸椎硬膜外、连续竖脊肌平面和 1 型竖脊肌间沟阻滞（QLB）已在成人人群中进行了描述和应用。除了小儿腹部移植外，儿科中不同类型手术的区域麻醉技术的安全性和益处已得到广泛记录，但在小儿腹部移植中数据仍然很少。我们的主要目标是确定 QLB 是否在多模式治疗中提供充分的围手术期镇痛。次要目标是检查并发症以及对重症监护病房（ICU）和住院时间的影响。
我们对 2015 年 1 月至 2021 年 7 月在匹兹堡大学医学中心匹兹堡儿童医院接受腹部移植手术并接受单次 QLB 注射以控制疼痛的小儿患者进行了回顾性观察性研究。收集的数据包括：人口统计学、神经阻滞特征、围手术期阿片类药物消耗、非阿片类镇痛药的使用、每日疼痛评分以及住院和 ICU 住院时间。
42 名患者符合我们研究的纳入标准。我们的结果表明，QLB 可减少阿片类药物的消耗，促进早期拔管，防止 ICU 重新插管，并缩短 ICU 和住院时间。
QLB 是可行的，可以作为小儿实体器官移植术后多模式镇痛的一种方法。
