Erector Spinae Plane Block Versus Quadratus Lumborum Block (ESP-QLB-Peds)

January 8, 2026 updated by: Amr omar abdulrazzaq omar, Assiut University

Erector Spinae Plane Block Versus Quadratus Lumborum Block for Post Operative Analgesia in Pediatric Kidney Surgery

To compare the efficacy and safety of ultrasound-guided ESPB versus QLB for post-operative analgesia in children undergoing kidney surgery.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

The management of postoperative pain in pediatric kidney surgery is a critical component of enhanced recovery and improved patient outcomes. Effective analgesia minimizes opioid consumption and their associated side effects, facilitating early mobilization and discharge. Regional anesthesia techniques have gained prominence as opioid-sparing modalities in pediatric patients, with the erector spinae plane block (ESPB) and quadratus lumborum block (QLB) increasingly used in abdominal and renal surgeries.

The erector spinae plane block is a fascial plane block targeting the dorsal rami of spinal nerves, providing extensive analgesia for thoracic and abdominal procedures. It is considered relatively easy and safe to perform under ultrasound guidance and has been associated with effective postoperative analgesia and reduced opioid requirements in pediatric renal surgery. Additional advantages include shorter block performance time and a lower incidence of postoperative nausea and vomiting compared with other regional techniques.

The quadratus lumborum block involves local anesthetic deposition near the quadratus lumborum muscle and can be performed using different approaches, such as anterior and transmuscular techniques. These approaches provide both somatic and visceral analgesia for lower abdominal and renal surgeries. Continuous quadratus lumborum block has demonstrated effective postoperative pain control, reduced need for rescue analgesia, and minimal adverse events in pediatric renal procedures. It is also recognized for its favorable safety profile and its contribution to improved quality of recovery.

Although both ESPB and QLB are effective regional techniques for pediatric postoperative analgesia, studies comparing their efficacy have reported variable results. Some investigations have shown comparable pain scores and opioid consumption between the two blocks, while others suggest potential advantages of one technique over the other in terms of analgesic duration, side-effect profile, or patient satisfaction.

Pain assessment in pediatric patients remains challenging because of differences in age, cognitive development, and communication abilities. This necessitates the use of objective pain scoring systems and careful perioperative analgesic planning. Consequently, evaluating and comparing the analgesic efficacy and safety of these two regional blocks in pediatric kidney surgery is of particular clinical importance.

The rationale of this study is to provide direct comparative evidence on the effectiveness and safety of ultrasound-guided ESPB versus QLB for postoperative analgesia in pediatric kidney surgery. Clarifying which technique offers superior analgesic control with fewer side effects may help optimize perioperative pain management protocols and improve postoperative outcomes. This study aims to assess postoperative pain scores, opioid consumption, block-related complications, and recovery quality in order to guide anesthetic decision-making in pediatric renal surgery

Study Type

Interventional

Enrollment (Estimated)

100

Phase

  • Not Applicable

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

Children of both sexes, aged 2-12 years, with ASA physical status I-II scheduled for elective unilateral kidney surgery will be eligible.

Exclusion Criteria:

  • Infection at the site of needle insertion
  • Allergy to local anesthetics
  • Parental refusal of consent

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

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

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Erector spinae plane block
Ultrasound-guided erector spinae plane block performed at the thoracic level using a multi-shot technique after completion of surgery and before extubation for pediatric kidney surgery to provide postoperative analgesia.
Procedure: Quadratus lumborum block teqnique

All blocks were performed under ultrasound guidance. A high-frequency linear probe was positioned in the mid-axillary line cranial to the iliac crest to identify the abdominal wall muscles (external oblique, internal oblique, and transversus abdominis). The probe was then moved dorsally until the transversus abdominis muscle became aponeurotic, which was followed medially to visualize the quadratus lumborum (QL) muscle at its attachment to the L4 transverse process adjacent to the psoas muscle.

Using an in-plane anterior-to-posterior approach, the block needle was advanced toward the anterior border of the QL muscle. After confirming the needle tip position with a 1 ml saline test injection, 0.5 ml/kg of 0.25% bupivacaine was administered. Bilateral injections were performed for midline incisions, while unilateral injections were used for paramedian incisions.

Procedure: Erector spinae plane block Technique
Ultrasound-guided erector spinae plane block performed at the thoracic level using a single-shot technique in pediatric patients undergoing kidney surgery to provide postoperative analgesia. Local anesthetic is injected deep to the erector spinae muscle over the transverse process with expected craniocaudal spread.
Active Comparator: Quadratus lumborum block
Ultrasound-guided quadratus lumborum block performed using a multi-shot technique, after completion of surgery and before extubation of anesthesia for pediatric kidney surgery to provide postoperative analgesia.
Procedure: Quadratus lumborum block teqnique

All blocks were performed under ultrasound guidance. A high-frequency linear probe was positioned in the mid-axillary line cranial to the iliac crest to identify the abdominal wall muscles (external oblique, internal oblique, and transversus abdominis). The probe was then moved dorsally until the transversus abdominis muscle became aponeurotic, which was followed medially to visualize the quadratus lumborum (QL) muscle at its attachment to the L4 transverse process adjacent to the psoas muscle.

Using an in-plane anterior-to-posterior approach, the block needle was advanced toward the anterior border of the QL muscle. After confirming the needle tip position with a 1 ml saline test injection, 0.5 ml/kg of 0.25% bupivacaine was administered. Bilateral injections were performed for midline incisions, while unilateral injections were used for paramedian incisions.

Procedure: Erector spinae plane block Technique
Ultrasound-guided erector spinae plane block performed at the thoracic level using a single-shot technique in pediatric patients undergoing kidney surgery to provide postoperative analgesia. Local anesthetic is injected deep to the erector spinae muscle over the transverse process with expected craniocaudal spread.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Time to first rescue analgesia
Time Frame: 24 hours
measured from extubation until the first request/administration of analgesia, in hours
24 hours

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Total analgesic consumption
Time Frame: 24 hours
Total 24-hour postoperative analgesic consumption (mg/kg paracetamol, µg/kg fentanyl).
24 hours
Postoperative pain score
Time Frame: 24 hours
FLACC pain score assessed at 0, 1, 2, 6, 12, and 24 hours postoperatively.
24 hours
Incidence of postoperative nausea and vomiting
Time Frame: 24 hours
Incidence of PONV within 24 hours postoperatively.
24 hours
Block-related complications
Time Frame: 24 hours
Incidence of block-related complications.
24 hours
Postoperative hemodynamic stability
Time Frame: 24 hours
Changes in heart rate and blood pressure >20% from baseline.
24 hours
Parent satisfaction
Time Frame: 24 hours
Parent satisfaction measured using a 5-point Likert scale.
24 hours

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Assiut University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

December 25, 2025

Primary Completion (Estimated)

February 28, 2028

Study Completion (Estimated)

March 30, 2028

Study Registration Dates

First Submitted

December 25, 2025

First Submitted That Met QC Criteria

January 8, 2026

First Posted (Estimated)

January 16, 2026

Study Record Updates

Last Update Posted (Estimated)

January 16, 2026

Last Update Submitted That Met QC Criteria

January 8, 2026

Last Verified

January 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • Pediatric-Block-Study-2025

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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