A New Way to Tackle Pain After Surgery to Help Little Heroes Heal
Featured paper: Quadratus Lumborum Blockade for Postoperative Analgesia in Infants and Children Following Colorectal Surgery
Disclaimer: This content was generated by NotebookLM and has been reviewed for accuracy by Dr. Tram.
Surgery is a big deal for anyone, but when it involves infants and children, the stakes feel even higher. For parents and doctors, the biggest concern after a procedure is often the same: how do we keep the child comfortable while they heal? Traditionally, doctors have relied on strong medications like opioids or “spinal” blocks (neuraxial anesthesia) to manage pain. However, a group of researchers at Nationwide Children’s Hospital recently published a study in the Journal of Clinical Medicine Research about a different technique called the Quadratus Lumborum Block (QLB).
This study suggests that the QLB is not only a safe and fast way to manage pain in children undergoing abdominal surgery, but it might also help them need fewer heavy-duty pain medications.
What is a Quadratus Lumborum Block (QLB)?
To understand why this matters, we first have to look at how doctors manage pain. After a surgery on the stomach or “gut” (colorectal surgery), the body sends pain signals from the surgical site to the brain. To stop these signals, doctors can use regional anesthesia, which is like creating a “numbness bubble” around a specific part of the body.
The QLB is a type of “interfascial plane block”. This means a doctor uses an ultrasound machine to look through the skin and find a specific muscle in the lower back called the quadratus lumborum. Once they find the right spot, they inject a numbing medicine (local anesthetic) into the space next to the muscle. This medicine then spreads to the nerves that provide feeling to the abdomen, effectively “blocking” the pain before it can even start.
Why This Study Was Needed
While the QLB has been used in adults for years, there hasn’t been as much data on how well it works for children, especially those having major abdominal surgery like ostomy creation (where an opening is made in the belly for waste). Most previous reports on kids were based on very small groups of patients, which made it hard to tell if the procedure was truly safe for everyone.
The team at Nationwide Children’s Hospital decided to look back at four years of their own data from 2016 to 2020 to see how their young patients fared. They looked at 204 QLB procedures performed on 163 children. The patients ranged from tiny babies only 2 days old to young adults aged 19.
The Results: Low Pain and High Safety
The researchers found that the QLB was incredibly effective. On a pain scale of 0 to 10 (where 0 is no pain and 10 is the worst pain possible), the median pain scores were less than 2 during the entire 72-hour period after surgery. In fact, by the third day, the median pain score was 0.
Here are some of the most important takeaways from their findings:
- It’s Fast: It took a median of only 5 minutes for the doctors to perform the block.
- It’s Successful: The block worked as intended in 99% of the cases.
- It’s Safe: There were zero major complications. The researchers looked for things like infections, bleeding, or “local anesthetic systemic toxicity” (where the numbing medicine gets into the bloodstream and causes problems), but they didn’t find a single instance of these issues.
- It Reduces Opioid Use: While 85.3% of the kids still needed some opioids, the total amount they needed was quite low and decreased every day they were in the hospital.
Why This is a “Game Changer” for Kids
You might wonder why doctors don’t just use a “spinal” or “epidural” block, which is common in many surgeries. While those work well, they aren’t always the best choice for children with certain medical conditions.
For example, many of the children in this study (about 42%) were born with anorectal malformations, which are conditions where the lower digestive tract doesn’t develop correctly. These children often have abnormalities in their spine or a “tethered spinal cord,” which makes it risky or impossible to put a needle near their spine for a traditional epidural. Because the QLB is performed on the side of the body near the muscle, away from the spine, it is a much safer alternative for these “little heroes”.
Additionally, traditional spinal blocks can sometimes cause “motor blocks,” which means the patient can’t move their legs for a while, or “urinary retention,” which means they have trouble going to the bathroom. The QLB avoids these side effects, allowing kids to potentially get up and move around sooner.
Comparing the Data
To see just how much the QLB helped, the researchers compared their results to other published studies where kids didn’t get this kind of nerve block. In one study of children having similar surgeries without regional anesthesia, the average pain score was 4.5 out of 10, more than double the scores seen in the QLB group.
Furthermore, almost 99% of children in that other study required opioids, compared to only 85% in the QLB study. While that might seem like a small difference, every bit of “opioid-sparing” helps reduce side effects like nausea, itching, or slowed breathing.
The Science of the “Shamrock”
One interesting detail in the study is the “anterior” or “transmuscular” approach the doctors used. When the doctors look at the ultrasound, they see a shape called the “Shamrock sign”.
- The stem of the shamrock is a part of the spine (the L4 transverse process).
- The leaves are three different muscles: the erector spinae, the psoas major, and the quadratus lumborum.
By identifying this “shamrock,” doctors can precisely drop the numbing medicine in front of the QL muscle. This specific approach is thought to provide better coverage because the medicine can spread more easily to the nerves that travel through the abdominal wall.
What This Means for the Future
The researchers concluded that the QLB is now the “technique of choice” at their hospital for children having surgery related to an ostomy. It provides excellent pain control, has a “negligible” risk of side effects, and is very efficient for the surgical team.
However, the experts aren’t stopping there. They suggest that more research is needed to figure out the perfect dose of medicine for different ages and to see if adding other medications to the numbing mix (like a steroid called dexamethasone) could make the pain relief last even longer.