General Anesthesia Combined with Quadratus Lumborum Block Reduces Emergence Delirium in Children after Laparoscopic Surgery: A Randomized Clinical Trial.

Abstract

Background: Emergency delirium (ED) is a common and serious postoperative complication especially after pediatric surgery. Quadratus lumborum block (QLB) are critical components of the multimodal, opioid-sparing analgesia regimens, which provide effective analgesia, reduce opioid consumption, and attenuate surgical stress response. Therefore, this trial was designed to validate the hypothesis that the adjunctive use of QLB reduces the incidence of ED after laparoscopic surgery in children.

Methods: Children aged 1-6 years who underwent laparoscopic surgery under general anesthesia were randomly divided into general anesthesia combined with QLB group (Group G+Q) or general anesthesia group (Group G). The primary outcome was the incidence of ED in postanesthesia care unit (PACU), the incidence of delirium 24 hrs postoperatively, extubation time, length of stay in PACU, opioid consumption and pain score were recorded.

Results: From July 2020 to October 2022, 292 children were randomized and 287 completed the study. The incidence of delirium in Group G+Q were significantly lower than that in Group G in PACU (16.1% vs 47.9%, P<0.001) and 24 hrs postoperatively (3.4% vs 11.1%; P<0.05). The time of extubation time (21.2±11.4 min vs 18.2±11.8 min; P<0.05) and PACU stay in Group G were significantly longer than Group G+Q (57.2±20.3 min vs 48.9±20.4 min, P<0.01) compared with Group G.

Discussion: General anesthesia combined with QLB can significantly reduce the incidence of ED, shorten the extubation time and PACU residence time, and improve the quality of resuscitation.