Comparison of the effects of caudal block, TAP block and quadratus lumborum block on postoperative pain and analgesic consumption during lower abdominal surgery in pediatric patients

Aim: The aim of this study is to compare the effects of three ultrasound guided regional analgesia techniques (quadratus lumborum plane block, transversus abdominis plane block, caudal epidural block) on postoperative opioid consumption, pain scores, side effects and complications, length of stay, patient satisfaction in children undergoing lower abdominal surgery. Material and Methods: 145 children aged 2-8 who would undergo lower abdominal surgery were included in this prospective, randomized, double-blind study, after obtaining informed consent from parents or guardians. Closed envelope method is used for randomisation. Patients and postoperative follow-ups were blind to the technique. Patients were randomized by closed envelope method and divided into three groups. After general anesthesia, caudal block, TAP Block or QLB were administered prior to incision. As a local anesthetic, 0.5 ml/kg was administered for TAP and QLB, and 0.7 ml/kg bupivacaine was administered at a concentration of 0.25% in the caudal block. Postoperative 15, 30, 45 minutes and 1. 2. 6.12. 24. and 48. hour pain scores were recorded using the FLACC scale. If the FLACC score was > 3, tramadol was administered as an additional analgesic 1mg/kg. In addition, time of first analgesic need, total number of patients with analgesic need, side effects and complications, length of stay, parental satisfaction and the presence of chronic pain was recorded at the end of the 3. month. Results: Study is completed with 135 patient. Although there was statistically no difference between FLACC scores in all follow-up times, 24. hour FLACC scores were found lower in the QLB group compared to TAP group. (p=0.03) While the duration of first analgesic needs and total opioid consumption did not make a significant difference statistically, the total number of patients with analgesic needs was significantly lower in the QLB group. (p=0.015). There was no significant difference in the frequency of postoperative nausea, vomiting, chronic pain and patient satisfaction, while lenght of stay were significantly lower in the QLB group. (p=0.019) Conclusion: In our study, considering low pain scores among the three ultrasound guided techniques in patients underwent lower abdominal surgery it can be said that, these three techniques are efficient as postoperative analgesic choice. But number of patients in need of resque analgesic and lenght of stay in QLB group were equal to caudal blok group, superior to TAP group. Key Words: Quadratus Lumborum Block, Transversus Abdominis Block, Caudal Block, Pediatric Anesthesia, Regional Anesthesia, Pain