Comparison of ESP and QL Blocks for Postoperative Pain in Pediatric Appendectomy (ESP-QLB) (ESP-QLB)

Comparative Effects of Erector Spinae Plane and Quadratus Lumborum Blocks on Postoperative Pain and Analgesic Requirement in Pediatric Appendectomy: A Prospective Randomized Controlled Trial

This prospective randomized controlled clinical trial aims to compare the analgesic effectiveness of the Erector Spinae Plane (ESP) block and the Quadratus Lumborum (QL) block in pediatric patients undergoing appendectomy. Both regional anesthesia techniques have been shown to reduce opioid requirements and improve postoperative recovery in children; however, there is limited evidence directly comparing their efficacy. In this study, eligible participants will be randomly assigned to receive either an ESP or a QL block in addition to standard general anesthesia before surgical incision. Postoperative outcomes will include pain scores, total opioid consumption, time to first analgesic requirement, mobilization time, parental satisfaction, length of hospital stay, block-related complications and block performance time. The findings are expected to guide clinicians in selecting the most effective regional anesthesia technique for postoperative pain control in pediatric appendectomy.

Study Overview

• Status: Completed
• Conditions: Erector Spinae Block; Quadratus Lumborum Nerve Block
• Intervention / Treatment: Drug: Quadratus Lumborum Block (QLB); Drug: Erector Spinae Plane Block

Detailed Description

Appendectomy is one of the most common emergency surgical procedures in children, and effective postoperative analgesia plays a key role in patient comfort, early mobilization, and reduced opioid exposure. Regional anesthesia techniques have gained increasing importance in pediatric anesthesia due to their opioid-sparing effect and favorable safety profile. Among these techniques, the Erector Spinae Plane (ESP) block and the Quadratus Lumborum (QL) block have shown promising results; however, there is a lack of high-quality randomized controlled trials directly comparing their clinical efficacy in pediatric appendectomy.

This study will prospectively enroll pediatric patients between 3 and 13 years of age who are scheduled to undergo appendectomy. After obtaining informed parental consent, participants will be randomly allocated to either the ESP block group or the QL block group. All blocks will be performed under ultrasound guidance using 0.25% bupivacaine at a dose of 0.5 mL/kg following the induction of general anesthesia. Standardized postoperative analgesia protocols will be applied to all participants.

Pain scores will be measured at predefined time points using a validated pediatric pain scale. Secondary outcomes will include total opioid consumption during the first 24 hours, the time to first rescue analgesic requirement, mobilization time, length of hospital stay, parental satisfaction scores, and any block-related complications. Patient data will be collected by trained investigators who will be blinded to group allocation.

The goal of this trial is to determine whether ESP or QL block provides superior postoperative pain control and recovery in pediatric appendectomy. The results may contribute to evidence-based recommendations for regional anesthesia selection in pediatric surgical practice.

• Study Type: Interventional
• Enrollment (Actual): 60
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Kütahya, Turkey (Türkiye), 43100
    • Kutahya City Hospital
  • Kütahya
    • Kütahya, Kütahya, Turkey (Türkiye), 43100
      • Kutahya City Hospital Anesthesia and Reanimation Department

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Patients aged 3-13 years
• Diagnosis of acute appendicitis requiring appendectomy
• ASA physical status I-II
• Planned general anesthesia with intraoperative regional block (ESP or QL block)
• Written informed consent obtained from parents or legal guardians

Exclusion Criteria:

• Refusal of regional block by family or anesthesia team
• Coagulopathy or anticoagulant medication use
• Local infection at the block injection site
• Known allergy or contraindication to local anesthetics
• Neurological or neuromuscular disorders
• Cognitive impairment preventing postoperative pain assessment
• Conversion to open surgery
• Intraoperative complications requiring deviation from study protocol

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: QLB Block; Ultrasound-guided transmuscular QL block using 0.25% bupivacaine (0.5 mL/kg) before surgical incision.	Drug: Quadratus Lumborum Block (QLB); Ultrasound-guided transmuscular QL block performed under general anesthesia using 0.25% bupivacaine (0.5 mL/kg) before surgical incision.
Active Comparator: ESP Block; Ultrasound-guided ESP block at the L1 level using 0.25% bupivacaine (0.5 mL/kg) before surgical incision.	Drug: Erector Spinae Plane Block; Ultrasound-guided ESP block at the L1 level under general anesthesia using 0.25% bupivacaine (0.5 mL/kg) before surgical incision.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Postoperative Pain Score	Pain intensity will be evaluated at rest using the Oucher Pain Rating Scale. Higher scores indicate greater pain.	Pain scores will be assessed at 1, 6, 12, and 24 postoperative hours.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Total Analgesic Consumption	Total dose of analgesic medications (NSAIDs and/or non-opioid analgesics) administered within the first 24 hours after surgery will be recorded. Higher values indicate greater analgesic requirement.	Recorded during the first 24 hours after surgery
Time to First Analgesic Requirement	Time interval between the end of surgery and the first administration of rescue analgesia will be recorded in minutes. Longer intervals indicate better analgesic effectiveness.	From the end of surgery until the first documented analgesic requirement, assessed up to 24 hours postoperatively
Time to Mobilization	Time from the end of surgery until the patient is able to ambulate with assistance or independently will be recorded in minutes. Shorter time indicates faster functional recovery.	From the end of surgery until the first successful ambulation with or without assistance, assessed up to 24 hours postoperatively
Length of Hospital Stay	Duration of hospitalization will be recorded from admission to discharge and expressed in hours. Longer duration indicates delayed recovery.	From the end of surgery until hospital discharge, typically within 24-48 hours.
Parents' Postoperative Pain Measure (PPPM)	Postoperative pain will be evaluated by parents using the Parents' Postoperative Pain Measure (PPPM). Higher scores indicate greater pain intensity.	Assessed at 1, 6, 12, and 24 hours postoperatively
Block-Related Complications	ny adverse events potentially related to the regional block (e.g., local hematoma or bruising, infection at the injection site, neurological symptoms, or suspected local anesthetic systemic toxicity) will be recorded as present or absent.	From block performance until the end of surgery and during the first 24 hours postoperatively
Block performance time	Block performance time was defined as the time (in seconds) from the initial placement of the ultrasound probe on the skin to the completion of local anesthetic injection. The duration was recorded by an independent observer using a stopwatch.	During block performance, prior to surgical incision

Collaborators and Investigators

• Sponsor: Zeycan Kahya
• Investigators: Principal Investigator: Süleyman Camgöz, Kütahya Health Sciences University

Study record dates

Study Major Dates

• Study Start (Actual): December 13, 2025
• Primary Completion (Actual): April 15, 2026
• Study Completion (Actual): April 28, 2026

Study Registration Dates

• First Submitted: November 16, 2025
• First Submitted That Met QC Criteria: December 10, 2025
• First Posted (Actual): December 24, 2025

Study Record Updates

• Last Update Posted (Actual): May 5, 2026
• Last Update Submitted That Met QC Criteria: April 29, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Postoperative Pain; Regional Anesthesia; Quadratus Lumborum Block; Erector Spinae Plane Block; Pediatric Appendectomy; Ultrasound-Guided Nerve Blocks; Analgesic Requirement
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain, Postoperative
• Other Study ID Numbers: KSBU-ESPQL-2026

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: The sharing of IPD is permitted under the condition that the organisation requesting its sharing provides a valid reason.
• IPD Sharing Time Frame: Beginning 6 months after publication of the study results and continuing for 2 years.
• IPD Sharing Access Criteria: Researchers must submit a methodologically sound proposal. Data will be shared after approval by the principal investigator. Data will be transferred in de-identified form only.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ANALYTIC_CODE; CSR

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No