Korean J Pain.  2024 Jan;37(1):59-72. 10.3344/kjp.23268.

Postoperative analgesic effects of the quadratus lumborum block in pediatric patients: a systematic review and meta-analysis

• Park I
• Park JH
• Shin HJ
• Na HS
• Koo BW
• Ryu JH
• Oh AY

• KMID: 2550133
• DOI: http://doi.org/10.3344/kjp.23268

Abstract

Background
This study assessed the postoperative analgesic efficacy and safety of the quadratus lumborum block (QLB) in pediatric patients.
Methods
Electronic databases were searched for studies comparing the QLB to conventional analgesic techniques in pediatric patients. The primary outcome was the need for rescue analgesia 12 and 24 hours after surgery. Secondary outcomes covered the Face-Legs-Activity-Cry-Consolability Scale (FLACC) scores at various time points; parental satisfaction; time to the first rescue analgesia; hospitalization time; block execution time; block failure rates, and adverse events.
Results
Sixteen randomized controlled trials were analyzed involving 1,061 patients. The QLB significantly reduced the need for rescue analgesia both at 12 and 24 hours after surgery (12 hours, relative risk [RR]: 0.45; 95% confidence interval [CI]: 0.01, 0.88; 24 hours, RR: 0.51; 95% CI: 0.31, 0.70). In case of 24 hours after surgery, type 1 QLB significantly reduced the need for rescue analgesia (RR: 0.56; 95% CI: 0.36, 0.76). The QLB also exhibited lower FLACC scores at 1 hour (standardized mean difference [SMD]: –0.87; 95% CI: –1.56, –0.18) and 6 hours (SMD: 1.27; 95% CI: –2.33, –0.21) following surgery when compared to non-QLB. Among QLBs, type 2 QLB significantly extended the time until the first rescue analgesia (SMD: 1.25; 95% CI: 0.84, 1.67). No significant differences were observed in terms of parental satisfaction, hospitalization time, block execution time, block failure, or adverse events between QLB and non-QLB groups.
Conclusions
The QLB provides non-inferior analgesic efficacy and safety to conventional methods in pediatric patients.

Keyword

Analgesia; Meta-Analysis; Nerve Block; Pain; Pain Measurement; Pain; Postoperative; Pediatrics; Systematic Review

Figure

• 

  Fig. 1 Preferred Reporting Items for Systematic Reviews and Meta-analyses flow diagram of study selection. A total of 302 articles were identified through searches of the electronic databases. After excluding 124 duplicate studies, 156 articles were removed from the article pool based on the fitness of the title and abstract. The full texts of 22 eligible studies were then reviewed, and six studies were excluded. Finally, 16 RCTs were included in the final analysis. RCT: randomized controlled trial, QLB: quadratus lumborum block, TFB: transversalis fascia block.

• 

  Fig. 2 Forest plots for the number of patients needing rescue analgesia (A) 12 hr and (B) 24 hr after surgery. QLB reduced the need for rescue analgesia at both 12 hr (P value < 0.001) and 24 hr (P value < 0.001, Egger’s P value = 0.506) after surgery. QLB: quadratus lumborum block, TFB: transversalis fascia block, IO: intravenous opioid, TAP: transversus abdominis plane block, II/IH: ilioinguinal/iliohypogastric nerve block, ESPB: erector spinae plane block, CB: caudal block, II: incision line injection, CI: confidence interval, FE: fixed effects, RE: random effects. aDifferent study by the same author published at a different year (patient enrollment periods do not overlap).

• 

  Fig. 3 Forest plots for the number of patients needing rescue analgesia 24 hr after surgery depending on the type of QLB: (A) type 1 QLB; (B) type 2 QLB; and (C) type 3 QLB. Type 1 QLB reduced the need for rescue analgesia at 24 hr post-surgery (P value < 0.001), but type 2 QLB and type 3 QLB showed no difference in the need for rescue analgesia compared on non-QLB (P value = 0.071 and P value =0.243, respectively). QLB: quadratus lumborum block, IO, intravenous opioid, TAP: transversus abdominis plane block, CB: caudal block, ESPB: erector spinae plane block, II/IH: ilioinguinal/iliohypogastric nerve block, II: incision line injection, CI: confidence interval, RE: random effects, FE: fixed effects. aDifferent study by the same author published at a different year (patient enrollment periods do not overlap).

• 

  Fig. 4 Forest plots for (A) parental satisfaction score; (B) time to first rescue analgesia; and (C) total hospitalization time between the QLB and non-QLB groups. Parental satisfaction score did not differ between QLB and non-QLB (P = 0.360). There was a weak association between QLB and extended time to first rescue analgesia (P = 0.049). No difference in total hospitalization time was observed between the two groups (P = 0.547). QLB: quadratus lumborum block, SD: standard deviation, SMD: standardized mean difference, CI: confidence interval, ESPB: erector spinae plane block, CB: caudal block, TFB: transversalis fascia block, TAP: transversus abdominis plane block, IO: intravenous opioid, II/IH: ilioinguinal/iliohypogastric nerve block.

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