P6

ENHANCING PAEDIATRIC ORCHIDOPEXY OUTCOMES: THE ROLE OF QUADRATUS LUMBORUM (QL) BLOCKS IN PLAN A CURRICULUM

A.Shepherd¹, W. Paine¹, M. Alabdah¹, S. Boyle²

¹South East Scotland School of Anaesthesia, Edinburgh, UK

²Royal Hospital for Children and Young People, Edinburgh, UK

Introduction:

Regional anaesthesia techniques are increasingly pivotal in optimising perioperative care for paediatric surgical procedures, emphasising improved pain management and overall patient outcomes. This retrospective service evaluation investigates the efficacy of the newly introduced lateral quadratus lumborum (QL) in the context of paediatric orchidopexy, a common procedure for undescended testes correction. Given the lateral QL is now emphasised in the anaesthetic curriculum with introduction to the paediatric “Plan A” blocks and has gained attention in its efficacy for other abdominal wall surgeries, we wished to ascertain its effectiveness for orchidopexy when compared to other regional approaches and within the context of our established practice in a tertiary paediatric hospital (1) (2).

Methods:

A retrospective service evaluation was conducted on 250 paediatric patients undergoing orchidopexy at our tertiary paediatric centre. Procedures included Fowler-Stevens or open single-stage approaches. Regional anaesthesia methods assessed comprised caudal, ilioinguinal via landmark and ultrasound guidance, the newly introduced lateral QL block, and a no-regional approach with local anaesthetic per surgical preference. Blocks were evaluated against key parameters such as day case stay, intraoperative opiates, recovery times and opiate requirements.

Research and Ethical approval was deemed unnecessary after consultation with NHS Lothian clinical research governance department.

Results:

Results demonstrated a significant reduction in average day case stay length (35 minutes) compared to other approaches. Intraoperative opiate requirements were notably lower, with only 6% of QL-supported surgeries requiring opiates. Importantly, these benefits did not lead to delays in anaesthesia time, suggesting that despite a learning curve, QL blocks did not prolong the overall anaesthesia process (3).

Discussion:

The introduction of lateral QL blocks as part of the Plan A curriculum showcased success, offering benefits to patients, and positively impacting departmental workload. Interestingly, QL patients received more Oramorph when returning to the day case ward.  However, we believe this could be due to outdated conventions of care, with Oramorph being given as a first line agent in the majority of cases where simple analgesia was available. These behaviours made the analysis of postoperative opiate requirements more difficult and emphasises the importance of regular service evaluation within a department.

By providing insights into immediate benefits and broader implications for departmental workflow, this service evaluation contributes to the evidence for regional anaesthesia in paediatric surgery. The findings support the integration of QL blocks into the standard repertoire for optimising orchidopexy procedures, ultimately enhancing outcomes within a tertiary paediatric centre.

References:

1. K. El-Boghdadly, N. Desai, S. Halpern, L. Blake, P. M. Odor, S. Bampoe, B. Carvalho, P. Sultan. Quadratus lumborum block vs. transversus abdominis plane block for caesarean delivery: a systematic review and network meta-analysis. 3, s.l. : Anaesthesia, 2021, Vol. 76.
2. A. M. E. Pearson, S. Roberts, L. R. Turbitt. New blocks on the kids: core basic nerve blocks in paediatric anaesthesia. 1, s.l. : Anaesthesia, 2023, Vol. 78.
3. L. R. Turbitt, E. R. Mariano and K. El-Boghdadly. Future directions in regional anaesthesia: not just for the cognoscenti.12 June 2019, RAUK Editorial.