Bilateral QLB in emergency pediatric laparoscopic surgery
Author(s): ,
Bakalov, S.*
CHR de Niort, Anesthesia, Niort, France
Hristova, R.
CHR de Niort, Anesthesie, Niort, France
Disclosure(s): I have nothing to disclose
Dr. Stefan Bakalov
Dr. Stefan Bakalov

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Background and Aims:

Our team was interested of the efficacy of the transmuscular QLB in emergency laparoscopic pediatric surgery for perioperative analgesia. The rationale for our research is that Borglum and Bendtsen nicely demonstrated the extensive spread of local anesthetic in the narrow interfascial plane (between PM  and QL) form L1 up to T4 and towards the paravertebral spaces which could explain the observed somatic and visceral analgesia and lower pain scores in comparison with the TAP block.   


We enrolled a cohort of 8 cases of emergency laparoscopic pediatric surgery (diffuse peritonitis and typical acute appandicitis) operated on under GA.

GA was inducted with 0.5 mcg/kg Sufentanil, Propofol, rocuronium and was maintained with sevoflurane 1 – 1.5 MAC. The bilateral QLB was performed after the induction with 10 - 15 ml ropivacaine 0.375 % on each side. The maximal allowable dose of 3 mg/kg was respected.

All children received Paracetamol 15 mg/kg at the end of surgery. NSAIDs were not administered.


No need to add more opiates after the induction dose during the surgery. 
3 childrens - no pain in PACU
4 children needed one administration of Nalbuphine 0.2 mg/kg in PACU

Just one child needed two applications of Nalbuphine 0.2 mg/kg postoperetively

The next 24 hours the patients needed just paracetamol 15 mg/kg four times a day.

No incisions site infiltration of LA, no other opiates.

No side effects were observed.  


 The bilateral QLB markedly decreased opiate needs intra- and postoperatively. It certainly has place in the intra and postoperative multimodal analgesia in pediatric emergency laparoscopic surgery

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