Pediatric sonar guided Quadratus Lumborum block.

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Ultrasound-guided quadratus lumborum block (QL) is considered now as one of the new truncal abdominal block as it is effective in preventing somatic pain associated with upper and lower abdominal surgeries. In all patients, sonar guided QL block will be performed after induction of anesthesia and before start of surgery. The patients will be randomly classified into two groups according to the block approach using a computer-generated table. Group I include patients (20 patients) in whom QL block will be done using anterior approach (i.e. trans-muscular QL block). Group II include patients (20 patients) in whom QL block will be done using intramuscular approach. Surgery will be started 10 minutes after performing the block. Any complications occurring during surgery will be recorded carefully. All patients will receive paracetamol 15 mg/kg at the end of the surgery. Postoperative pain level will be assessed using FLACC score. The score ranges from 0 to 10. The 0 score indicates no pain while 10 score indicates the most severe pain. The postoperative pain score will be assessed at 2, 4, 6 12, 24 hours in the surgical ward by another anesthetist blinded to group allocation. Patients with FLACC score equal to 4 will receive tramadol 1 mg/kg IV. The primary outcome measure is the number of patients who need rescue analgesia in the first 24 hours. The secondary outcome measures are FLACC score, heart rate, non-invasive blood pressure at 2, 4, 6 12, 24 hours postoperatively and postoperative complications. Using PASS11 program (SPSS Inc., Chicago, IL., USA), setting alpha error at 5% and power at 80%, result from previous study showed that among QL group, the percentage of children needed analgesia is as 12.5% compared to 41.6% among the second group. Based on this, the needed sample is 27 cases per group. (54 cases total)

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