Quadratus Lumborum Block as Intraoperative Analgesic Treatment in Pediatric with Hirschprung’s disease

Pita Mora  Lesmana; Marilaeta Cindryani Ra  Ratumasa; I Made  Subagiartha; Tjokorda Gde Agung  Senapathi

doi:10.22146/jka.v12i1.14973

Pita Mora Lesmana Anesthesiology and Intensive Therapy Department, Faculty of Medicine, Udayana University – Prof IGNG Ngoerah General Hospital
Marilaeta Cindryani Ra Ratumasa Anesthesiology and Intensive Therapy Department, Faculty of Medicine, Udayana University – Prof IGNG Ngoerah General Hospital
I Made Subagiartha Anesthesiology and Intensive Therapy Department, Faculty of Medicine, Udayana University – Prof IGNG Ngoerah General Hospital
Tjokorda Gde Agung Senapathi Anesthesiology and Intensive Therapy Department, Faculty of Medicine, Udayana University – Prof IGNG Ngoerah General Hospital

DOI: https://doi.org/10.22146/jka.v12i1.14973

Keywords: QLB, Intraoperative Analgesic, Hirschprung, Pediatric

Abstract

Overview: A 4-year-old boy diagnosed with Hirschsprung's disease since birth will undergo a planned Duhamel procedure. Internationally, the prevalence of Hirschsprung's disease is approximately 1 in 1,500 to 1 in 7,000 live births and usually requires immediate intervention through surgical procedures. The extended length of pediatric surgeries presents a unique challenge for anesthesiologists aiming to minimize the use of opioids, considering their less desirable effects in this patient population. In this case, we opted for the use of quadratus lumborum block (QLB) as intraoperative analgesia. This refers to a meta-analysis by Wen-li Zhao et al, all suggest that QL block offers more effective postoperative pain relief in children after lower abdominal surgeries.

Management: After the patient was intubated, we performed a quadratus lumborum block using an anterior approach as an intraoperative analgesia technique. The local anesthetic used was 0.375% ropivacaine + 4 mg dexamethasone, volume 10 ml on both sides. Dermatom covered anterior QL block includes T4 to T12-L1, blocks the anterior and the lateral cutaneous branches of the nerves

Result: No additional opioid dose administered during the surgical procedure. Conclusion: The QLB in pediatric patients is quite effective in managing pain during surgery for patients undergoing the Duhamel procedure.