WOFAPS 2025 8th World Congress of Pediatric Surgery

Sherif Mansour, Paul Cullis, Su Ying Ong

Royal Hospital for Children & Young People, Edinburgh, United Kingdom

Aim:
Effective postoperative pain control is vital after paediatric laparoscopic appendicectomy, but opioid use carries risks. Quadratus lumborum (QL) blocks provide visceral and somatic analgesia and may reduce opioid requirements. This study assessed the impact of QL blocks on postoperative analgesia in children.

Methods:
We performed a retrospective case–control study (January 2023–September 2024) of patients aged 1–23 undergoing laparoscopic appendicectomy. The intervention group received ultrasound-guided bilateral QL blocks alongside general anaesthesia; controls received local anaesthetic at port sites. Primary outcomes were intraoperative and postoperative opioid use and time to discharge.

Results:
146 patients were included (67 QL; 79 controls), with 49 cases of perforated appendicitis (19 QL; 30 controls). The QL group required lower intraoperative opioids (mean 0.11 mg/kg vs 0.20 mg/kg) and had reduced total opioid consumption during admission, particularly in perforated cases (0.65 mg/kg vs 1.37 mg/kg). In non-perforated cases, the benefit persisted but was less pronounced. The QL group had a longer average hospital stay (103 hours vs 73 hours), likely reflecting higher case complexity. No complications from QL blocks were observed.

Conclusion:
QL blocks modestly reduced opioid requirements after laparoscopic appendicectomy, with a significant benefit in perforated appendicitis. Despite longer hospital stays in the QL group, likely due to case severity, QL blocks appear to be a safe, opioid-sparing adjunct, especially for complex cases. Further prospective studies could clarify their impact on recovery and length of stay.