BACKGROUND: Ultrasound?guided quadratus lumborum block (QLB) is a regional anesthetic technique which can provide post-op pain control for pediatric patients undergoing abdominal surgery. We hypothesized that the quadratus lumborum block would be as efficacious as a caudal block in providing pain control.

OBJECTIVE: To compare the postoperative analgesic effect of ultrasound-guided QLB versus ultrasound-guided caudal block among 1-6 years old children undergoing lower abdominal and urological surgeries in Philippine Children's Medical Center.

METHODS: This is a single-blinded randomized control trial. 50 patients enrolled aged between 1 and 6 years. The patients were randomly classified into the caudal block group and quadratus lumborum block group. The primary outcome is the need for analgesia during the first 24 hours.

RESULTS: A significant difference in the proportion of patients who requested for rescue analgesia was observed with caudal block having more patients in need of analgesic (100% CB vs 48% QLB, p<0.001). No postoperative complication was observed.

CONCLUSIONS AND RECOMMENDATIONS: The quadratus lumborum block was more effective in reducing the postoperative pain management during the initial 48 hours. Quadratus lumborum block is recommended for future pediatric procedures requiring postoperative pain control, safety, practicality and economy.

Human ; Male ; Female ; Pre-adolescent (a Child 6-12 Years Of Age) ; Child Preschool (a Child Between The Ages Of 2 And 5) ; Analgesia ; Pain, Postoperative ; Diagnostic Imaging

OBJECTIVE: To compare the effectiveness of preoperative Japanese acupuncture for prevention of post-operative nausea and vomiting (PONV) in non-sedated children for surgery under general anesthesia.

METHODS: This is an RCT studying the effectiveness of press-tack Japanese needles in P6 prior to any sedatives in children age 5-18 years old for surgery under general anesthesia (n=66). Patients were randomized to receive either press-tack needle (n=33) or an identical press-tack without the metal component (n=33). Incidence of PONV was reported using BARF scale. Children, parents, anesthesiologists, and nurses were blinded to group assignment.

RESULTS: Eight of 33 (22%) in the intervention group while 17 of 33 (51.52%) in the placebo group experienced PONV (RR = 0.47, 95% CI [0.24-0.94], p-value 0.0224). One case reported an adverse event of worsening of nausea and vomiting.

CONCLUSIONS: Japanese acupuncture at P6 prior to sedation using press-tack needle significantly reduced the incidence of PONV in children after general anesthesia. KEYWORDS: PONV, POV, P6, PC6, Japanese acupuncture, Acupuncture, RCT

Human ; Male ; Female ; Adolescent (a Person 13-18 Years Of Age) ; Pre-adolescent (a Child 6-12 Years Of Age) ; Postoperative Nausea And Vomiting ; Vomiting, Postoperative ; Pericardium ; Acupuncture

BACKGROUND: The dose of Sugammadex for rescue reversal of intense neuromuscular block has not been studied in children. The only recommended dose of Sugammadex in children is 2mg/kg to reverse a shallow block. OBJECTIVES: To assess the efficacy and safety of Sugammadex 2mg/kg and 4mg/kg as immediate rescue reversal of intense rocuronium-induced neuromuscular block in pediatric patients METHODS: 80 children, aged 2 to 11 years old, requiring general anesthesia were enrolled in this randomized prospective study. Group 1 given Sugammadex 2mg/kg (40 subjects) while Group 2 received Sugammadex 4mg/kg (40 subjects), at the end of the procedure if PTC=0. The Recovery Time was recorded (TOF ratio ≥0.9) (Primary Outcome). Discharge readiness in the PACU was assessed using Modified Aldrete Scale (Secondary Outcome). Monitoring of adverse effects in the ward continued until 24 hours postoperatively. RESULTS: There were significantly more patients in the Sugammadex 4mg/kg that had a recovery time of ≤2min as compared to those given Sugammadex 2mg/kg (p=0.012). There was no significant difference in the Aldrete score between the two groups (p=0.2776). All patients achieved a very satisfactory discharge score in the PACU. The adverse effects experienced by the patients in the two doses of Sugammadex in the PACU and up to 24 hours postoperatively were not significantly different. CONCLUSION: Sugammadex 4mg/kg can be considered safe and effective as an immediate reversal agent for rocuronium-induced intense neuromuscular blockade in children. RECOMMENDATIONS Clinicians should identify if Sugammadex 6mg/kg, compared with 4mg/kg, would translate to a shorter Recovery time to a TOF ratio of 0.9. The time from TOF ratio of 0.9 to the time of extubation should be measured to increase the efficacy and safety assessment of Sugammadex in this age group.