Perioperative effect of general anesthesia combined with caudal block or quadratus lumborum block in children undergoing laparoscopic surgery

Objective To investigate the effects of general anesthesia combined with caudal block or quadratus lumborum block on hemodynamics and recovery quality in children undergoing laparoscopic hernia surgery.

Methods  Fifty-five children with inguinal hernia treated in our hospital from March to June 2022 were selected, and were performed laparoscopic hernia surgery. They were randomly divided into three groups: control group(G group, given general anesthesia, n=17), general anesthesia combined with quadratus lumborum block group (GQ group, n=17) and general anesthesia combined with caudal block group (GC group, n=21). The scores of Pediatric Anesthesia Emergence Delirium (PAED) and Faces, Legs, Activity, Cry, and Consolability (FLACC) were recorded, hemodynamic parameters including mean arterial pressure (MAP), heart rate (HR), and pulse blood oxygen saturation (SpO₂) before anesthesia (T₀), at the beginning of anesthesia (T₁) and at the end of operation (T₂) were observed, and the total amount of anesthetics and opioids during operation, operation time, anesthesia time, extubation time of tracheal catheter, hospital stay and occurrence of postoperative complications were recorded.

Results Compared with G group, PAED scores of GC group and GQ group at difference time pointswere showed significant difference (P < 0.001). There was no significant difference in PAED scores between GC group and GQ group at each time point (P=1.000). Compared with G group, FLACC score of GC group and GQ group at each time point showed a significant difference(P < 0.001), and there was no significant difference in FLACC score between GC group and GQ group at each time point (P=0.572). Compared with group G, MAP and HR in GC and GQ groups decreased at T₁ and T₂ (P < 0.001). Compared with T₀, MAP and HR in GC and GQ groups decreased at T₁ and T₂, while were increased in the G group (P < 0.001). Compared with the G group, the total amount of propofol, cisatracurium, fentanyl and remifentanil in GC and GQ groups decreased, but the difference was not statistically significant (P=0.166, 0.091, 0.100, 0.402). The anesthesia time of GC and GQ groups was longer than that of the G group, while the extubation time was shorter than that of the G group (P < 0.001).

Conclusion  Caudal block and quadratus lumborum block have higher safety in laparoscopic internal ring suture surgery in children, which can maintain hemodynamic stability, promote early recovery and reduce the restlessness rate of recovery period.