The effects of abdominal nerve block techniques as preventive analgesia on pediatric laparoscopic procedures: A randomized controlled trial

Figures & data

Figure 1. Ultrasound-guided TAPB.

Figure 2. Ultrasound-guided QLB.

Figure 3. Flowchart for patient involved in the study.

Table 1. Patient’s data.

Variables	C Group	TAP Group	QL Group	P value
	N = 30	N = 30	N = 30	All	C vs TAP	C vs QL	TAP vs QL
Age (years)	(1-7) 4.1 ± 1.7	(1-7) 4.3 ± 1.4	(1-7) 4 ± 1.5	0.74	0.61	0.80	0.45
Weight (Kg)	(10-25) 16.4 ± 3.8	(10-26) 17.1 ± 4.1	(10-25) 16.3 ± 3.5	0.65	0.45	0.92	0.40
Sex n (%)				0.46	0.39	0.24	0.75
M	26(86.7)	24(80%)	25(83.3%)
F	4(13.3%)	6(20%)	5(16.7%)
ASA n (%)				0.58	0.24	0.78	0.37
I	20(6.7%)	24(80%)	21(70%)
II	10(33.3%)	6(20%)	9(30%)
Types of operations				0.96	0.96	1.00	0.90
Undescended testis	9(30%)	10(33.3%)	10(33.3%)
Inguinal hernia	15(50%)	16(53.3%)	12(40%)
Hydrocele	5(16.7%)	3(10%)	6(20%)
Appendectomy	1(3.3%)	1(3.3%)	2(6.7%)
Operative time (min)	(28-5) 37.9 ± 4.9	(28-45) 37.5 ± 4.7	(30-45) 37.7 ± 4.3	0.96	0.78	0.91	0.86

ANOVA test with post hoc test (LSD) was used to analyze the variables, and the results were provided as (Range) Mean ± SD, (n %): numbers and percentages by chi-square test, and Fisher’s exact test. *P is noteworthy when it is ≤ 0.05. QL Group: Quadratus lumborum block; TAP Group: transversus abdominis plane block; C Group: control group. M: Male, F: Female ASA: American Society of Anaesthesia.

Table 2. Pain score (FLAAC scale).

Post- operative time interval for FLACC measurement	C Group	TAP Group	QL Group	P value
	N = 30	N = 30	N = 30	All	C vs TAP	C vs QL	TAP vs QL
0.5 hr.	2 (2-3)	0 (0–1)	0 (0–0)	<0.001*	<0.001*	<0.001*	0.001*
1 hr.	2 (2,3)	0 (0–1)	0 (0–0)	<0.001*	<0.001*	<0.001*	0.001*
1.5 hr.	3 (3)^#	0 (0–1)	0 (0–0)	<0.001*	<0.001*	<0.001*	0.001*
2 hr.	5 (4-5)^#	0 (0–1)	0 (0–0)	<0.001*	<0.001*	<0.001*	0.001*
4 hr.	5 (5-6)^#	2 (1-2)^#	0 (0–1)^#	<0.001*	<0.001*	<0.001*	<0.001*
6 hr.	8 (7-8)^#	2 (2-3)^#	2 (1-3)^#	<0.001*	<0.001*	<0.001*	<0.001*
8 hr.	4 (4-5)^#	4 (3-4)^#	3 (2-3)^#	<0.001*	0.003*	<0.001*	<0.001*
10 hr.	5 (4-5)^#	5 (4-6)^#	3 (2-4)^#	<0.001*	0.222	<0.001*	<0.001*
12 hr.	5 (5-6)^#	6 (4-6)^#	3 (3-5)^#	<0.001*	0.872	<0.001*	<0.001*
18 hr.	8 (7-8)^#	5 (4-7)^#	5 (4-5)^#	<0.001*	<0.001*	<0.001*	0.091
24 hr.	6 (5-7)^#	6 (5-6)^#	5 (5-6)^#	0.148	0.569	0.049*	0.209

The variables are displayed as the median (IQR) analyzed by the Mann Whitney test between each pair of groups and the Kruskal Wallis test between the three groups; *indicates a significant level at p value < 0.05 between groups. Wilcoxon For data between two occasions within each group, significant difference ^#p < 0.05 with a 0.5-hour time interval. QL Group: Quadratus lumborum block; TAP Group: transversus abdominis plane block; C Group: control group.

Table 3. Heart rate (beat/min) in the three studied groups.

Peri-operative HR measurement	C Group	TAP Group	QL Group	P value
	N = 30	N = 30	N = 30	All	C vs TAP	C vs QL	TAP vs QL
baseline	(50–150) 95.6 ± 23.5	(52–131) 89.7 ± 18.8	(71–117) 90.6 ± 10.5	0.407	0.216	0.290	0.856
5 min	(121–151)^# 137 ± 8.6	(94–196)^# 137.3 ± 25.4	(117–150)^# 135.4 ± 6.8	0.886	0.936	0.704	0.646
10 min	(119–149)^# 133.2 ± 8.5	(84–178)^# 135.3 ± 24.7	(119–152)^# 131.2 ± 6.9	0.608	0.615	0.621	0.320
15 min	(112–143)^# 129.7 ± 8.2	(72–181)^# 126.2 ± 23.6	(115–141)^# 125.6 ± 6.5	0.523	0.366	0.294	0.883
20 min	(106–138)^# 124.4 ± 7.7	(101–124)^# 114.6 ± 6	(72–160)^# 111.9 ± 22.1	0.002*	0.008*	0.001*	0.455
30 min	(107–132)^# 118.8 ± 7.7	(43–139)^# 103.7 ± 21	(90–114)^# 102.2 ± 6.8	<0.001*	<0.001*	<0.001*	0.668
45 min	(91–132)^# 113.7 ± 8.3	(57–135) 95 ± 19.5	(81–103) 91.8 ± 6.1	<0.001*	<0.001*	<0.001*	0.328
60 min	(95–124)^# 112.6 ± 7.1	(85–109)^# 98 ± 6.4	(80–108) 92.1 ± 6.9	<0.001*	<0.001*	<0.001*	0.001*
75 min	(99–124)^# 112.1 ± 6	(89–114)^# 99.9 ± 5.8	(76–105) 92.6 ± 6.6	<0.001*	<0.001*	<0.001*	<0.001*
90 min	(96–121)^# 111.2 ± 5.3	(93–116)^# 103 ± 5.3	(86–117)^# 98.1 ± 7.1	<0.001*	<0.001*	<0.001*	0.002*
120 min	(100–119)^# 112.7 ± 4.4	(96–117)^# 106.9 ± 5.6	(95–123)^# 105.5 ± 6.6	<0.001*	<0.001*	<0.001*	0.333

The results are shown as (Range) Mean ± SD and analyzed by ANOVA test with post hoc test (LSD), and *: Significant level at p value < 0.05 between groups. For quantitative data between two occasions within each group, the Paired Samples T test was employed; #: Significant difference at p value < 0.05 with the baseline. HR: Heart Rate; QL Group: Quadratus lumborum block; TAP Group: transversus abdominis plane block; C Group: control group.

Table 4. Mean arterial pressure (mmHg) in the three studied groups.

Peri-operative MBP measurement	C Group	TAP Group	QL Group	P value
	N = 30	N = 30	N = 30	All	C vs TAP	C vs QL	TAP vs QL
baseline	(65–90) 76.1 ± 6.7	(58–94) 77.7 ± 8	(65–94) 78.2 ± 7.2	0.525	0.410	0.278	0.792
5 min	(70–95)^# 80.7 ± 6	(54–106) 79.1 ± 15.9	(68–94) 80 ± 6.8	0.836	0.551	0.789	0.742
10 min	(67–95) 79.4 ± 7.3	(53–105) 76.6 ± 15.5	(64–94) 79.5 ± 6.5	0.480	0.303	0.971	0.287
15 min	(67–87) 78.5 ± 5.8	(39–104) 76 ± 15.5	(65–89) 76.8 ± 5.8	0.607	0.330	0.502	0.761
20 min	(71–90)^# 79.7 ± 4.6	(45–105) 75.1 ± 15.1	(64–86) 73 ± 4.8	0.026*	0.049*	0.008*	0.395
30 min	(66–85) 74.9 ± 5	(39–98) 71 ± 14.8	(63–81)^# 72.7 ± 4.1	0.265	0.105	0.362	0.472
45 min	(61–75)^# 67.6 ± 3.9	(26–86)^# 62.9 ± 12.6	(51–74)^# 62.8 ± 6.2	0.045*	0.033*	0.029*	0.951
60 min	(64–80)^# 71.5 ± 3.9	(51–81)^# 69.6 ± 7.6	(57–85)^# 68.5 ± 6.8	0.182	0.254	0.069	0.488
75 min	(62–87) 74 ± 6.3	(61–87) 74.4 ± 6.2	(52–73)^# 65.3 ± 5.8	<0.001*	0.800	<0.001*	<0.001*
90 min	(67–88) 77.1 ± 4.8	(66–89) 75.9 ± 5.6	(64–88) 76.5 ± 6.5	0.728	0.427	0.699	0.683
120 min	(64–98) 77.8 ± 7.7	(72–95) 80.6 ± 5.3	(66–95) 80.4 ± 7.7	0.233	0.124	0.158	0.897

The results are shown as (Range) Mean ± SD and analyzed by ANOVA test with post hoc test (LSD), and *: Significant level at p value < 0.05 between groups. For quantitative data between two occasions within each group, the Paired Samples T test was employed; #: Significant difference with the baseline. MBP: Mean Arterial Pressure; QL Group: Quadratus lumborum block; TAP Group: transversus abdominis plane block; C Group: control group.

Table 5. Postoperative analgesic requirements.

Variables	C Group	TAP Group	QL Group	P value
	N = 30	N = 30	N = 30	All	C vs TAP	C vs QL	TAP vs QL
Time for the first paracetamol requirement (hours)	(4-6) 4.8 ± 0.7	(9-18) 14.5 ± 2.2	(14-24) 19 ± 2.9	<0.001*	<0.001*	<0.001*	<0.001*
Total paracetamol requirement in 24 hs postoperative (mg)	(212–832) 497.5 ± 168.6	(128–253) 190.1 ± 34.9	(77–162) 124.1 ± 22.7	<0.001*	<0.001*	<0.001*	0.013*
Frequency of paracetamol doses	(3-3) 3 ± 0	(1-3) 1.9 ± 0.6	(1-4) 1.1 ± 0.5	<0.001*	<0.001*	<0.001*	<0.001*
Number of patients need ketorolac n (%)	21(70%)	7(23.3%)	3(10%)	<0.0001*	<0.001*	<0.0001*	0.299

ANOVA test with post hoc test (LSD) was used to analyze the variables as (Range) Mean ± SD (n %): numbers and percentages by chi-square test, and Fisher’s exact. *P is noteworthy when it is <0.05. QL Group: Quadratus lumborum block; TAP Group: transversus abdominis plane block; C Group: control group.

Figure 4. The complications.

The chi-square test and Fisher’s exact for numbers and percentages (n %) were used to analyze the variables. *P is significant when at ≤0.05. QL Group: Quadratus lumborum block; TAP Group: transversus abdominis plane block; C Group: control group.

Table 6. Parent satisfaction with post-operative analgesia.

Point scale	C Group	TAP Group	QL Group	P value
	N = 30	N = 30	N = 30	All	C vs TAP	C vs QL	TAP vs QL
1	4(13.3%)	0	0	0.015*	0.056	0.056	0
2	12(40%)	0	0	0.0001*	0.0001*	0.0001*	0
3	10(33.3%)	6(20%)	6(20%)	0.382	0.191	0.191	0.626
4	4(13.3%)	14(46.7%)	12(40%)	0.015*	0.005*	0.020*	0.397
5	10(33.3%)	10(33.3%)	12(40%)	0.001*	0.0001*	0.0001*	0.395

The point scale represented as n %: number and percentage, analyzed by chi-square test and Fisher’s exact. *P is noteworthy when it is ≤ 0.05. QL Group: Quadratus lumborum block; TAP Group: transversus abdominis plane block; C Group: control group.