Transversus Abdominis Plane Lock Versus Quadratus Lumborum Block in Children

NCT06861556 | Completed

• 1 other identifier: 222022
• Study Type: interventional
• Target: 90
• Locations: 1 country
• Sites: 1

Brief Summary

Although abdominal wall surgeries are also as routinely performed on pediatric patients, postoperative pain in children has remained under-researched compared to adults. Consequently, there has been a growing need for adapting regional analgesia to this distinct population. While the Transversus Abdominis Plane Block (TAPB) and Quadratus Lumborum Block (QLB) have been established as potent sensory blocks in adult practice, data on their efficiency in pediatric abdominal parietal surgeries remain scarce. The investigators aimed to compare the analgesic effect of lateral TAPB versus posterior QLB in children undergoing elective abdominal wall surgery.

Conditions

Peripheral Nerve Block; Post Operative Analgesia; Ultrasound-guided Regional Anesthesia

Keywords

Transversus Abdominis Plane block; QUADRATUS LUMBORUM BLOCK; post operative analgesia; Ultrasound; Children

Outcome Measures

Primary Outcomes (1)

• Time to first rescue analgesia

  Time (in minutes) from the completion of the block to first analgesia administration based on postoperative pain score (assessed using FLACC (Face Legs Activity Crying Consolability) in ward \>3)

  3 hours

Secondary Outcomes (6)

• block Failure rate

  30 minutes

• FLACC scale pain scores

  2 hours

• PPMP scale scores

  24 hours

• Total analgesic consumption

  24 hours

• Post operative nausea and vomiting (PONV)

  24 hours

Study Arms (2)

TAP block group

ACTIVE COMPARATOR

Ultrasound-guided TAP block group

Procedure: Ultrasound guided Transversus Abdominis Plane block with 0.2ml/kg bupivacaine 0.25%

QLB block group

ACTIVE COMPARATOR

Ultrasound-guided Quadratus Lumborum block group

Procedure: Ultrasound-guided Quadratus Lumborum block with 0.2ml/kg bupivacaine 0.25%

Interventions

Ultrasound guided Transversus Abdominis Plane block with 0.2ml/kg bupivacaine 0.25% PROCEDURE

The operator applied a linear ultrasound probe transversally to the mid-axillary line between the costal margin and iliac crest. Landmarks were then identified as three muscles layers beneath the subcutaneous tissue; from external to internal lay respectively the external oblique muscle (EO), the internal oblique muscle (IO) and the transversus abdominis (TA). The needle was inserted in plane from the iliac crest level on the midaxillary line advancing towards the midline to the fascia laying between the IO and the TA muscles until pop detection. A clear aspiration ruled out vascular effraction. Finally, the space between the two muscle planes was hydrodissected with the bupivacaine.The end goal was visualizing the IO moving upward leaving room to a hypoechoic lens-shaped local anesthetic distribution.

TAP block group

Ultrasound-guided Quadratus Lumborum block with 0.2ml/kg bupivacaine 0.25% PROCEDURE

The patient was laid in a lateral decubitus position. The operator applied the probe transversally on the iliac crest directing the indicator to display the back muscles encompassed by the thoracolumbar fascia (TLF).The intended image was spotted by the emergence of the transverse process L4, delimiting the stem of a shamrock-like shape. Quadratus lumborum (QL) muscle represented the upper leaf of the shamrock, and psoas major (PM) and erector spinae (ES) stood respectively for the anterior and posterior leaves. The needle was inserted in plane from the postero-median lumbar wall directed antero-laterally with tip aiming at the posterior border of the QL muscle adjacent to the ES muscles. Pop detection indicated the middle TLF where the local anesthetic would spread, homogenous and resistance-free

QLB block group

Eligibility Criteria

• Age: 1 Year - 10 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17)

You may qualify if:

• We included patients aged from 1 to 10 years old with American Society of Anesthesiologists (ASA) physical status I or II.

You may not qualify if:

• Later on after allocation, patients were excluded for block failure or major perioperative complications

Sponsors & Collaborators

• Tunis University: lead

Study Sites (1)

Bechir Hamza Children's Hospital

Tunis, 1029, Tunisia

Location

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Full Professor of Anesthesiology and Intensive Care, head chief of the department of Anesthesia and Intensive Care

Model Details: The patients were randomly assigned into two groups to receive after a standardized general anesthesia induction either an ultrasound-guided TAP block or Quadratus Lumborum block with 0.2ml/kg bupivacaine 0.25%

Study Record Dates

• First Submitted: November 24, 2024
• First Posted: March 6, 2025
• Study Start: October 1, 2022
• Primary Completion: March 31, 2023
• Study Completion: June 28, 2023
• Last Updated: March 6, 2025

Record last verified: 2025-03

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)