Efficacy of dexmedetomidine as an adjuvant to Quadratus lumborum block for pediatrics undergoing laparoscopic pyeloplasty. A prospective randomized double blinded study.

BACKGROUND We designed this study to evaluate dexmedetomidine as an adjuvant to local anesthetics in Quadratus lumborum block (QLB) in pediatrics either interfascial versus intravenous on the quality of postoperative analgesia and incidence of side effects. METHODS Fifty pediatric patients ASA I and II, from eight to thirteen years old posted for laparoscopic pyeloplasty were randomized either to: QLB dexmedetomidine intravenous (QD IV) group or QLB dexmedetomidine interfascial (QD IF) group. A 24-h postoperative morphine consumption (primary outcome), time to first analgesic request, postoperative pain and sedation scores were compared. The recovery time after anesthesia and the incidences of intraoperative and postoperative hypotension or bradycardia were recorded. RESULTS The median [IQR] 24 h postoperative morphine consumption in QD IF group [0.05 (0.05-0.10) mg/kg] was lower compared with QD IV group [0.15 (0.10-0.20) mg/kg] (P<0.001). Longer time to first analgesic request was noted in QD IF group [505 (395-583) min] in comparison to QD IV group [306 (258-388) min] (P<0.001). Pain scores were lower in QD IF group at six and eight hours postoperatively. Sedation scores were lower in QD IF group on admission to PACU and two hours postoperatively. Intraoperative hypotension and bradycardia were lower in QD IF group. Longer recovery time in QD IV group. CONCLUSIONS Interfascial dexmedetomidine adjuvant to QLB provided better postoperative analgesia in terms of less morphine consumption, better pain scores and longer time to first analgesic request when compared with the IV dexmedetomidine.