Postoperative Analgesic Effects of Quadratus Lumborum Block Versus Transversus Abdominis Plane Block in Pediatric Lower Abdominal Surgeries: A Systematic Review and Meta-Analysis.

Abstract

Objective: Management of postoperative pain in pediatric patients is challenging. Traditional methods of postoperative pain management may not always provide adequate relief. We aim to compare the effect of Quadratus Lumborum Block (QLB) and Transversus Abdominis Plane Block (TAPB) on the quality of postoperative analgesia in pediatrics undergoing lower abdominal surgeries.

Methods: We systematically searched PubMed, Scopus, Web of Science, and Cochrane Library up to August 2024 for studies that compared QLB and TAPB in the context of pediatric lower abdominal surgery. Pooled mean difference (MD), standardized mean difference (SMD), and odds ratio (OR) were calculated by a random effect model using RevMan 5.4.

Results: Nine studies met the pre-defined inclusion criteria. Pooled analysis indicated that postoperative pain measured by the FLACC score was lower in the QLB group compared to the TAPB group (MD: -0.37; 95% CI: -0.51, -0.23; P < 0.00001). QLB was also associated with lower rescue analgesic demand (OR: 0.25; 95% CI, 0.13, 0.49; P < 0.0001), higher parent satisfaction (SMD: 0.78; 95% CI: 0.53, 1.02; P < 0.00001), longer time without the need for analgesic administration (MD: 1.04; 95% CI: 0.38, 1.71; P = 0.002), and lower paracetamol consumption (SMD: -1.40; 95% CI: -2.43, -0.36; P = 0.008). However, no significant difference was found in terms of postoperative nausea, vomiting, and heart rate.

Conclusion: QLB provides superior analgesia compared to TAPB in pediatrics undergoing lower abdominal surgeries.