Ultrasound-guided Quadratus Lumborum Block Versus Erector Spinae Plane Block for Postoperative Analgesia in Children Undergoing Elective Open Lower Abdominal Surgeries

NCT07853586 | Recruiting

• 1 other identifier: 7/2026ANET47
• Study Type: interventional
• Target: 60
• Locations: 1 country
• Sites: 1

Brief Summary

To compare the postoperative analgesic efficacy of ultrasound-guided Quadratus Lumborum Block (anterior approach) versus Erector Spinae Plane Block (T10-T12 level), both performed bilaterally with 0.25% bupivacaine (0.5 mL/kg per side), in the first 24 hours postoperatively in children undergoing elective open lower abdominal surgery under general anesthesia.

Conditions

Bilateral Inguinal Hernia Repair; Open Upper Abdominal Surgeries

Outcome Measures

Primary Outcomes (1)

• Time of first analgesic request

  in the first 24 hours

Secondary Outcomes (2)

• total opioid (fentanyl equivalent) consumption /ug

  the first 24 hours postoperatively

• postoperative pain intensity using the FLACC Scale (Face, Legs, Activity, Cry, Consolability)

  0, 30 minutes, 1, 2, 4, 6, 12, and 24 hours postoperatively.

Study Arms (2)

Ultrasound guided anterior quadratus lumborum block

ACTIVE COMPARATOR

Procedure: ultrasound guided anterior oudratus lumborum block

ultrasound guided erector spinae block

ACTIVE COMPARATOR

Procedure: Ultrasound guided erector spinae plane block

Interventions

ultrasound guided anterior oudratus lumborum block PROCEDURE

A high-frequency linear probe will be used to visualize the structures and a 22G, 80-mm echogenic needle will be inserted to deposit the drug. The probe will be placed above the iliac crest, and Petit's triangle will be identified. The three abdominal muscles (i.e., the external oblique, internal oblique, and transversus abdominus muscles) will be identified and will follow posteriorly until the layers of the Thoracolumbar Fascia (TLF) appeared as a bright hyper-echogenic line. The needle will be inserted in-plane along the posterior edge of the probe in anteromedial direction targeting the plane between the quadratus lumborum and psoas major muscle. After confirming the correct needle tip position and negative aspiration for blood, 0.5 mL/kg of 0.25% bupivacaine will be injected incrementally under real-time ultrasound guidance. The procedure will be repeated on the contralateral side.

Ultrasound guided anterior quadratus lumborum block

Ultrasound guided erector spinae plane block PROCEDURE

The patient will be placed in the prone or lateral decubitus position. The ultrasound probe will be positioned para-sagittally approximately 2-3 cm lateral to the midline at the T10-T12 vertebral level. The T11 transverse process will be identified deep to the erector spinae muscle complex. Using an in-plane caudal-to-cranial approach, a 22-gauge echogenic needle will be advanced until the tip contacts the transverse process. Following confirmation of correct plane by injection of 0.5-1 mL saline creating hydrodissection between the erector spinae and transverse process, 0.5 mL/kg of 0.25% bupivacaine will be injected incrementally. The procedure will be repeated contralaterally \].

ultrasound guided erector spinae block

Eligibility Criteria

• Age: 2 Years - 7 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17)

You may qualify if:

• Age: 2 to 7 years.
• ASA Physical Status Classification I or II .
• Scheduled for elective minor open lower abdominal surgery (bilateral inguinal hernia repair, orchiopexy, circumcision, bilateral hydrocele repair), pyeloplasty and ureteric reimplantation.
• Weight between 10 and 25 kg.

You may not qualify if:

• Known allergy or hypersensitivity to local anesthetics (amide class).
• Contraindications to regional anesthesia: coagulopathy (INR \> 1.5, platelets \< 80,000/mm³), local infection at the injection site, or raised intracranial pressure.
• Pre-existing neurological, neuromuscular, or spinal disorders.
• Significant hepatic dysfunction (Child-Pugh Class B or C) or severe renal impairment (eGFR \< 30 mL/min/1.73 m²).
• Previous abdominal or retroperitoneal surgery which likely to distort fascial planes at the injection site.
• Emergency or redo surgical procedures.
• Inability to assess postoperative pain due to pre-existing developmental or cognitive impairment preventing validated pain scale use.

Sponsors & Collaborators

• Menoufia University: lead

Study Sites (1)

Menoufia University

Alexandria, Egypt

RECRUITING

Central Study Contacts

Nevine Soliman, MD

CONTACT

201128861471; mostafanevine@gmail.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: QUADRUPLE
• Who Masked: PARTICIPANT, CARE PROVIDER, INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: SUPPORTIVE CARE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor

Study Record Dates

• First Submitted: September 26, 2026
• First Posted: October 2, 2026
• Study Start: October 1, 2026
• Primary Completion (Estimated): July 1, 2027
• Study Completion (Estimated): July 1, 2027
• Last Updated: October 2, 2026

Record last verified: 2026-07

Locations

EG (1)