Ultrasound-Guided Transversalis Fascia Plane Block Versus Quadratus Lumborum Plane Block for Analgesia After Appendectomy in Pediatrics

Ultrasound-Guided Transversalis Fascia Plane Block Versus Quadratus Lumborum Plane Block for Analgesia After Appendectomy in Pediatrics: A Prospective Randomized Study

This study aims to compare the effectiveness of ultrasound-guided Transversalis Fascia Plane block versus Quadratus Lumborum block for postoperative pain relief in pediatrics undergoing appendectomy.

Primary outcomes:

• Proportion of patients needing rescue analgesia within the first 24 postoperative hours.

Secondary outcomes:

• Visual Analogue Scale pain intensity measurements.
• Intraoperative Heart rate and mean arterial blood pressure will be recorded.
• Time to first analgesic request for patients needing rescue analgesia (Fentanyl).
• Block-related complications (e.g., hematoma, local anesthetic toxicity, lower limb weakness).
• Parents' satisfaction score.

Study Overview

• Status: Enrolling by invitation
• Conditions: Quadratus Lumborum Block; Appendectomy; Transversalis Fascia Plane Block
• Intervention / Treatment: Procedure: Transversalis Fascia Plane Block group; Procedure: Quadratus Lumborum Plane Block group

Detailed Description

Appendicectomy is amongst the most commonly performed surgery, with acute appendicitis being the most frequent reason for abdominal surgical emergencies in the world . The lifetime risk of appendicitis is 7-8%, with rising incidence in the newly industrialized countries . The prevailing treatment of choice for appendicitis is appendicectomy, which can be performed either 'open' or laparoscopically .

A major contributor to the pain experienced by a patient after abdominal surgery is the incision made in the abdominal wall . Almost 80% of patients undergoing surgery experience postoperative pain, and 80% of them reported moderate-to-severe pain intensity .

Traditional methods of postoperative pain management in children, such as systemic opioids and nonsteroidal anti-inflammatory drugs , may not always provide adequate relief, especially for more invasive procedures . These approaches can also be associated with side effects like sedation, nausea, and respiratory depression, which may complicate postoperative care and recovery . In recent years, regional anesthesia techniques have emerged as promising alternatives for postoperative pain management in various surgical populations Two specific regional blocks that have gained attention for their potential benefits in reducing postoperative pain after abdominal surgeries is the Quadratus Lumborum Block and the Transversus Facial Abdominal Plane block The Quadratus Lumborum Block targets the nerves supplying the lumbar plexus, providing analgesia to the anterior abdominal wall . It has been shown to be effective in adult patients undergoing lower abdominal surgery, offering improved postoperative pain scores and reduced opioid consumption compared to traditional pain management strategies .

Although, both Quadratus Lumborum Block and Transversus Facial Abdominal Plane block are frequently employed in pediatric anesthesia, evidence to guide clinical decisions on which block offers superior outcomes needs to be comprehensively reviewed. We aimed to compare the effectiveness of ultrasound-guided Transversalis Fascia Plane block versus Quadratus Lumborum block for postoperative pain relief in pediatrics undergoing appendectomy.

This study aims to compare the effectiveness of ultrasound-guided Transversalis Fascia Plane block versus Quadratus Lumborum block for postoperative pain relief in pediatrics undergoing appendectomy.

Primary outcomes:

• Proportion of patients needing rescue analgesia within the first 24 postoperative hours.

Secondary outcomes:

• Visual Analogue Scale pain intensity measurements.
• Intraoperative Heart rate and mean arterial blood pressure will be recorded.
• Time to first analgesic request for patients needing rescue analgesia (Fentanyl).
• Block-related complications (e.g., hematoma, local anesthetic toxicity, lower limb weakness).
• Parents' satisfaction score.

• Study Type: Interventional
• Enrollment (Estimated): 70
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Egypt
  • Tanta, Egypt
    • Tanta University

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• 70 patients aged between 7 and 12 years of both sexes undergoing appendectomy, American Society of Anesthesiologists (ASA) physical status of I or II

Exclusion Criteria:

• Refusal of parents to participate
• Patients with peritonitis
• History of allergy to bupivacaine and other amide local anesthetics
• Infection at the site of block needle entry
• Bleeding diathesis
• Neurological disorders
• American Society of Anesthesiologists ≥ III

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Group I: Transversalis Fascia Plane Block versus; Patients will receive general anesthesia and ultrasound-guided transversalis fascia plane block in a dose of 0.4 ml/kg of 0.25% bupivacaine administered prior to surgical excision	Procedure: Transversalis Fascia Plane Block group; 35 Patients will receive general anesthesia and ultrasound-guided transversalis fascia plane block in a dose of 0.4 ml/kg of 0.25% bupivacaine administered prior to surgical excision.
Experimental: Group II :Quadratus Lumborum Plane Block; patients will receive general anesthesia and a quadratus lumborum plane block in a dose of 0.4 ml/kg of 0.25% bupivacaine administered prior to surgical excision.	Procedure: Quadratus Lumborum Plane Block group; 35 patients will receive general anesthesia and a quadratus lumborum plane block in a dose of 0.4 ml/kg of 0.25% bupivacaine administered prior to surgical excision

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Proportion of patients needing rescue analgesia	within the first 24 postoperative hours.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Visual Analogue Scale	Visual Analogue Scale pain intensity measurements.	24 postoperative hours

Collaborators and Investigators

• Sponsor: Tanta University

Study record dates

Study Major Dates

• Study Start (Actual): June 30, 2025
• Primary Completion (Actual): May 20, 2026
• Study Completion (Estimated): May 20, 2026

Study Registration Dates

• First Submitted: May 25, 2026
• First Submitted That Met QC Criteria: May 25, 2026
• First Posted (Actual): June 1, 2026

Study Record Updates

• Last Update Posted (Actual): June 1, 2026
• Last Update Submitted That Met QC Criteria: May 25, 2026
• Last Verified: June 1, 2025

More Information

Terms related to this study

• Keywords: Pediatrics; Appendectomy; Transversalis Fascia Plane Block; Quadratus Lumborum Plane Block
• Other Study ID Numbers: 36264MS975/6/25

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: It will be available if it needed
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF

Drug and device information, study documents

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