Ultrasonogram-Guided Continuous Quadratus Lumborum Block as Pain Management in Pediatric Kidney Transplant Recipients: A Case Series

Adequate perioperative analgesia is essential to optimize recovery in pediatric transplant surgery. Regional anesthesia techniques, such as continuous quadratus lumborum block, have been identified as effective and safe options for managing perioperative pain in pediatric abdominal surgeries. However, data on its use in pediatric kidney transplants are limited. We present a case series of 8 pediatric patients who underwent kidney transplant between January 2022 and April 2024 at our institution because of stage V chronic kidney disease of various etiologies. Four patients had received hemodialysis and 2 had received continuous ambulatory peritoneal dialysis before transplant. After induction of general anesthesia, quadratus lumborum block was performed before the surgical incision. Patients were positioned in the left lateral decubitus position. Patients had ultrasonographic imaging using the subcostal approach to visualize the lateral abdominal muscle layers. Once the psoas major muscle was identified, an 18-gauge Tuohy needle was inserted 1 to 2 cm lateral to the ultrasonograph probe, targeting the quadratus lumborum muscle. A catheter was subsequently inserted anterior to the quadratus lumborum muscle. Each patient received continuous quadratus lumborum block with either 0.125% bupivacaine at a rate of 4 to 6 mL/hour for 24 hours or 0.2% ropivacaine at a rate of 6 mL/hour as part of a multimodal perioperative pain management protocol. The perioperative pain was effectively managed with minimal need for rescue analgesics, and no substantial adverse events were reported. Quadratus lumborum block is an accessible and safe technique with great potential to facilitate postoperative pain management, especially in pediatric patients undergoing kidney transplant.