Department of Anesthesia, Intensive Care, and Pain Management, Faculty of Medicine, Ain-Shams University, Cairo, Egypt.
Pain Physician. 2023 Mar;26(2):137-147.
Ultrasound-guided regional anesthesia techniques for perioperative analgesia in pediatric patients scheduled for lower abdominal surgeries can be achieved either by quadratus lumborum block (QLB) or caudal block (CB). Neostigmine was co-administered with caudal bupivacaine to shorten the onset and extend the duration of analgesia.
This study aimed to compare between 2 ultrasound-guided techniques used for perioperative analgesia (QLB with bupivacaine vs. CB with bupivacaine/neostigmine) regarding the total amount of rescue analgesic (acetaminophen mg/kg) used for pain relief at 24 hours postsurgery in pediatric patients undergoing lower abdominal surgeries in a developing country and to discuss existing barriers during the implementation of both techniques.
A randomized, double-blind, prospective, single-center study.
Ain-Shams University Hospitals.
Eighty pediatric patients scheduled for lower abdominal surgeries under general anesthesia were randomly allocated to receive either ultrasound-guided QLB using bupivacaine or ultrasound-guided CB using a bupivacaine/neostigmine mixture. The total amount of rescue analgesic (acetaminophen mg/kg) 24 hours postsurgery was considered as the primary outcome while the time to first rescue analgesia, pain score, postoperative nausea and vomiting, bradycardia, hypotension, and urinary retention were considered as secondary outcomes.
In the QLB group, the time to first rescue analgesia was longer whereas the total analgesic dose (mg/kg) was lower than the CB group (P < 0.001, P = 0.007, respectively). While, on the other hand, in CB group, the time to perform the block was shorter and Parents Satisfaction Score 24 h postsurgery was lower than the QLB group (P < 0.001, P < 0.001, respectively). Side effects were infrequent and comparable between the study groups.
First, the researchers did not assess the dermatomal level before or after the operation in either group. Second, the investigators should have noticed the first voiding time to demonstrate accurately the incidence of urine retention. Third, a cost-effectiveness analysis of perioperative costs (drugs, staff, resources being used) of these regional anesthesia techniques when applied in an ambulatory setting should have been done, which would be helpful for those in resource-limited settings.
Postoperative analgesia for pediatric patients undergoing lower abdominal surgeries can be safely and effectively achieved by QLB with bupivacaine and a CB with a bupivacaine/neostigmine mixture with priority given to CB, especially in resource-limited settings.
在计划进行下腹部手术的小儿患者中，超声引导的区域麻醉技术可通过腹横肌平面阻滞（QLB）或骶管阻滞（CB）来实现。新斯的明与布比卡因联合用于骶管阻滞，以缩短起效时间并延长镇痛持续时间。
本研究旨在比较两种用于围手术期镇痛的超声引导技术（QLB 布比卡因与 CB 布比卡因/新斯的明），以评估在发展中国家接受下腹部手术的小儿患者在术后 24 小时内缓解疼痛所需的总（解救性）镇痛药物（乙酰氨基酚 mg/kg），并讨论这两种技术在实施过程中存在的障碍。
随机、双盲、前瞻性、单中心研究。
艾因沙姆斯大学医院。
将 80 例计划在全身麻醉下接受下腹部手术的小儿患者随机分配至接受超声引导的 QLB 布比卡因或超声引导的 CB 布比卡因/新斯的明治疗。术后 24 小时内的总（解救性）镇痛药物（乙酰氨基酚 mg/kg）用量为主要结局，而首次解救性镇痛的时间、疼痛评分、术后恶心和呕吐、心动过缓、低血压和尿潴留为次要结局。
QLB 组首次解救性镇痛的时间较长，而总镇痛剂量（mg/kg）低于 CB 组（P<0.001，P=0.007）。另一方面，在 CB 组中，阻滞操作时间较短，术后 24 小时父母满意度评分较低（P<0.001，P<0.001）。两组的不良反应均不常见且相似。
首先，研究人员在两组中均未在手术前后评估皮节水平。其次，研究人员应该注意首次排尿时间，以准确显示尿潴留的发生率。第三，应进行围手术期成本（药物、人员、所用资源）的成本效益分析，以便在资源有限的情况下应用于门诊环境，这对资源有限的地区会有帮助。
对于接受下腹部手术的小儿患者，术后镇痛可以通过 QLB 布比卡因和 CB 布比卡因/新斯的明联合来安全有效地实现，特别是在资源有限的情况下，优先考虑 CB。
