Erector Spinae Plane Block Versus Quadratus Lumborum Block

Официальное название

Erector Spinae Plane Block Versus Quadratus Lumborum Block for Post Operative Analgesia in Pediatric Kidney Surgery

Обзор

To compare the efficacy and safety of ultrasound-guided ESPB versus QLB for post-operative analgesia in children undergoing kidney surgery.

Подробное описание

The management of postoperative pain in pediatric kidney surgery is a critical component of enhanced recovery and improved patient outcomes. Effective analgesia minimizes opioid consumption and their associated side effects, facilitating early mobilization and discharge. Regional anesthesia techniques have gained prominence as opioid-sparing modalities in pediatric patients, with the erector spinae plane block (ESPB) and quadratus lumborum block (QLB) increasingly used in abdominal and renal surgeries.

The erector spinae plane block is a fascial plane block targeting the dorsal rami of spinal nerves, providing extensive analgesia for thoracic and abdominal procedures. It is considered relatively easy and safe to perform under ultrasound guidance and has been associated with effective postoperative analgesia and reduced opioid requirements in pediatric renal surgery. Additional advantages include shorter block performance time and a lower incidence of postoperative nausea and vomiting compared with other regional techniques.

The quadratus lumborum block involves local anesthetic deposition near the quadratus lumborum muscle and can be performed using different approaches, such as anterior and transmuscular techniques. These approaches provide both somatic and visceral analgesia for lower abdominal and renal surgeries. Continuous quadratus lumborum block has demonstrated effective postoperative pain control, reduced need for rescue analgesia, and minimal adverse events in pediatric renal procedures. It is also recognized for its favorable safety profile and its contribution to improved quality of recovery.

Although both ESPB and QLB are effective regional techniques for pediatric postoperative analgesia, studies comparing their efficacy have reported variable results. Some investigations have shown comparable pain scores and opioid consumption between the two blocks, while others suggest potential advantages of one technique over the other in terms of analgesic duration, side-effect profile, or patient satisfaction.

Pain assessment in pediatric patients remains challenging because of differences in age, cognitive development, and communication abilities. This necessitates the use of objective pain scoring systems and careful perioperative analgesic planning. Consequently, evaluating and comparing the analgesic efficacy and safety of these two regional blocks in pediatric kidney surgery is of particular clinical importance.

The rationale of this study is to provide direct comparative evidence on the effectiveness and safety of ultrasound-guided ESPB versus QLB for postoperative analgesia in pediatric kidney surgery. Clarifying which technique offers superior analgesic control with fewer side effects may help optimize perioperative pain management protocols and improve postoperative outcomes. This study aims to assess postoperative pain scores, opioid consumption, block-related complications, and recovery quality in order to guide anesthetic decision-making in pediatric renal surgery

Вмешательства

• Процедура Quadratus lumborum block teqnique
  All blocks were performed under ultrasound guidance. A high-frequency linear probe was positioned in the mid-axillary line cranial to the iliac crest to identify the abdominal wall muscles (external oblique, internal oblique, and transversus abdominis). The probe was then moved dorsally until the transversus abdominis muscle became aponeurotic, which was followed medially to visualize the quadratus lumborum (QL) muscle at its attachment to the L4 transverse process adjacent to the psoas muscle.
• Процедура Erector spinae plane block Technique
  Ultrasound-guided erector spinae plane block performed at the thoracic level using a single-shot technique in pediatric patients undergoing kidney surgery to provide postoperative analgesia. Local anesthetic is injected deep to the erector spinae muscle over the transverse process with expected craniocaudal spread.

Первичные конечные точки

• Time to first rescue analgesia [Срок оценки: 24 hours]

Вторичные конечные точки (6)

• Total analgesic consumption [Срок оценки: 24 hours]
• Postoperative pain score [Срок оценки: 24 hours]
• Incidence of postoperative nausea and vomiting [Срок оценки: 24 hours]
• Block-related complications [Срок оценки: 24 hours]
• Postoperative hemodynamic stability [Срок оценки: 24 hours]
• Parent satisfaction [Срок оценки: 24 hours]

Критерии участия

Критерии включения

Children of both sexes, aged 2-12 years, with ASA physical status I-II scheduled for elective unilateral kidney surgery will be eligible.

Критерии исключения

• Infection at the site of needle insertion
• Allergy to local anesthetics
• Parental refusal of consent

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Рандомизированное

Модель

Параллельные группы

Маскирование

Простое слепое

Основная цель

Лечение

Центры проведения

Список центров уточняется — проверьте первичный протокол.

Публикации

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• Sac G, Ozulug M, Geiger MF, Freyhof J. Pseudophoxinus cilicicus, a new spring minnow from southern Anatolia (Teleostei: Leuciscidae). Zootaxa. 2019 Sep 16;4671(1):zootaxa.4671.1.8. doi: 10.11646/zootaxa.4671.1.8. PMID 31716597
• Aksu C, Gurkan Y. Ultrasound guided erector spinae block for postoperative analgesia in pediatric nephrectomy surgeries. J Clin Anesth. 2018 Mar;45:35-36. doi: 10.1016/j.jclinane.2017.12.021. Epub 2017 Dec 20. No abstract available. PMID 29274546
• Wu L, Zhang W, Wei Y, Zhang D. Comparison of the analgesic effects of ultrasound-guided erector spinae plane block and quadratus lumborum block: a systematic review and meta-analysis. Front Pharmacol. 2025 Aug 1;16:1640135. doi: 10.3389/fphar.2025.1640135. eCollection 2025. PMID 40822461
• Aksoy M, Aksoy AN, Yilmaz EPT, Senocak GNC, Dostbil A, Ozkan H. The effectiveness of erector spina plane, quadratus lumborum blocks, and intrathecal morphine for analgesia after cesarean: a randomized study. Rev Assoc Med Bras (1992). 2023 Nov 13;69(12):e20230867. doi: 10.1590/1806-9282.20230867. eCollection 2023. PMID 37971133
• Zhang M, Zhao S, Song S, Zhou H, Li M, Su P, Xu G. Comparative analgesic efficacy of erector spinae plane block versus quadratus lumborum block in laparoscopic renal cancer surgery: a double-blind randomized trial. Transl Androl Urol. 2025 Jul 30;14(7):2029-2042. doi: 10.21037/tau-2025-71. Epub 2025 Jul 28. PMID 40800097
• An Y, Li L, Li Z, Lan F, Wang T, Ou T, Liang C, Wang P, Jia X, Song H, Cui K, Luo H, Zhao L. Anterior quadratus lumborum block is superior to erector spinae plane block for analgesia after renal transplantation: a randomized controlled trial. BMC Anesthesiol. 2025 Jul 10;25(1):343. doi: 10.1186/s12871-025-03209-5. PMID 40640721
• Wu H, Huang J. Quadratus lumborum block versus caudal block in paediatric surgeries: a protocol for systematic review and meta-analysis. BMJ Open. 2025 May 28;15(5):e100085. doi: 10.1136/bmjopen-2025-100085. PMID 40441771

Идентификаторы

NCT: NCT07346417 · Pediatric-Block-Study-2025

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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