Yayik AM, Celik EC, Ahiskalioglu A.
Regional Training Hospital, Department of Anaesthesiology and Reanimation, Erzurum, Turkey.
Department of Anaesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey.

Abstract

Extracorporeal shock wave lithotripsy (ESWL) is the first choice of treatment for most urinary calculi. It is crucial for the success of ESWL to correctly focus the shock waves to the stone. However, movement of patients due to pain during ESWL can prevent the focus of shock waves and reduce the procedural success. In the literature, many regional anesthetic techniques have been applied in multimodal analgesia regimens for opioid sparing effect in adults undergoing ESWL [1]. However, there are no reports on the use of regional anesthesia methods in pediatric ESWL. General
anesthesia with tracheal intubation, intravenous anesthesia, or deep sedation with ketamine and propofol has been used for pediatric patients [2].
The Quadratus Lumborum Block (QLB), first described by Blanco [3], has been used in multimodal analgesia in adults and children undergoing abdominal surgery [4, 5]; it affects the T7–L1 dermatomes by spreading to the fascial plane. In our recent work, we detailed the use of QLB with ESWL in adult patients as case studies; the results proved effective [6]. Here, we first report the successful management of pediatric ESWL using QLB under light sedation.
The parents of the child whose data is used in this report provided written, informed consent to publish the case. The three-year-old girl was scheduled to undergo ESWL for a renal stone. On the day of the procedure, the patient was taken to the lithotripsy unit and a vascular access was administered. Standard ECG, peripheral capillary oxygen saturation (SpO2), and noninvasive blood pressure monitoring tests were performed. The patient received an IV with an initial dose of 0.1 mg/kg of midazolam and 1 mg/kg of propofol, followed by a continual infusion of 25–50 mcg/kg/min of the two drugs. The patient was placed in the left lateral decubitus position and was connected to a high-frequency linear ultrasound probe attached to an Esaote MyLab 30 ultrasound system. The anterior wall of the abdomen, external oblique, internal oblique, and transversus abdominis muscles were visualized. The transverse process, quadratus lumborum (QL) muscle, and psoas muscle were visualized using the lateralization of the ultrasound probe. A 6 ml mixture (3 ml of 0.5% bupivacaine and 3 ml of 2% lidocaine) was injected between the psoas major and the QL muscles using an in-plane technique (Fig. 1). ESWL started 10 min after the block.

J Clin Anesth. 2018 Jan 26;46:47-48. doi: 10.1016/j.jclinane.2018.01.016. [Epub ahead of print]