Analgesic Effect of Ultrasound-Guided Caudal Block Versus Quadratus Lumborum Plane Block in Lumbar Spine Surgery in Adult Patients: A Double-Blinded Prospective Comparative Study

doi:10.21203/rs.3.rs-5217929/v1

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Analgesic Effect of Ultrasound-Guided Caudal Block Versus Quadratus Lumborum Plane Block in Lumbar Spine Surgery in Adult Patients: A Double-Blinded Prospective Comparative Study

https://doi.org/10.21203/rs.3.rs-5217929/v1

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Background

Improving surgical results and patient rehabilitation requires effective postoperative pain management. This study compares analgesic efficacy and safety between quadratus lumborum plane (QLP) block and ultrasound-guided caudal block in adult patients following lumbar spine stabilization procedures.

Methods

At Fayoum University Hospital, a double-blind, randomized, controlled experiment was carried out. Three groups—a caudal block group, a QLP block group, or a Control group— were randomized to adult patients (18–60 years old) undergoing lumbar spine fixation as an elective procedure. The time to initially request a rescue analgesic, postoperative pain scores using the Numerical Pain Rating Scale (NPRS), total opioid consumption, intraoperative and postoperative hemodynamics, and the frequency of complications were used to measure the effectiveness of analgesics.

Results

111 patients were included, with 37 in each group. The QLP block group had a significantly longer time to first rescue analgesic dose compared to both the control (1 hour) and caudal block groups (15 hours vs. 1 hour and 5 hours, respectively; p < 0.001). Total opioid consumption was lowest in the QLP group (50 mg) compared to the control (150 mg) and caudal block groups (80 mg) (p < 0.001). Pain scores were lower in both the QLP and caudal block groups compared to the control group at most time points, with significant differences at 30 minutes, 1 hour, 2 hours, 4 hours, 8 hours, and 24 hours postoperatively (p < 0.001). Intraoperative fentanyl usage was significantly reduced in both the QLP and caudal block groups (p < 0.001). There were no significant differences in the rates of nausea and vomiting among the groups.

Conclusions

Ultrasound-guided caudal block and QLP block both offer advantages over standard care in managing postoperative pain following lumbar spine fixation. The caudal block provided better analgesic efficacy and hemodynamic stability compared to the control, while the QLP block demonstrated the lowest opioid consumption. These findings suggest that regional anaesthesia techniques can be effective alternatives to standard care, with the QLP block being particularly effective for prolonged pain relief.

Trial registration:

This study was conducted at Fayoum University Hospital with approval from the ethics committee, the local institutional board, and approval number M696 from the ethical committee. This trial is randomized, double-blind, and controlled. Qualified patients signed a thorough informed consent form before recruitment and randomization.

Caudal block

Quadratus lumborum plane block

Lumbar spine surgery

Postoperative pain management

Ultrasound-guided anaesthesia

Postoperative pain following surgery is frequently made worse by pain that is not well managed, particularly in the case of lumbar spine surgery (1, 2). There is a strong correlation between successful management of postoperative pain following lumbar spine surgery, better surgical outcomes, shorter hospital stays, and decreased risk of developing chronic pain (3–6). Despite these benefits, opioid-mediated pain treatment has been associated with significant side effects, such as respiratory depression, cardiovascular stress, delayed wound healing, decreased cognitive function, and gastrointestinal complications (7). The quadratus lumborum plane block (QLB) and ultrasound-guided caudal block are prominent methods for treating postoperative pain (8, 9). By obstructing pain-transmitting nerves in the caudal epidural space at the base of the spine, an anaesthetic drug is injected to relieve pain in the lower back and pelvis (10). Alternatively, QLB attempted to provide analgesia for surgeries involving the lower abdomen and lumbar spine by injecting anaesthesia into the fascial plane around the quadratus lumborum muscle, focusing on the nerves supplying the abdominal wall (11–13). The economic impact of adverse drug events is profound; in the United States, for example, adverse drug events are estimated to cost between 17 and 29 billion dollars annually (14). Studies have shown significant differences in length of stay, charges and costs of hospital admissions due to adverse drug events (15)

Although ultrasound-guided caudal block and QLB are two modalities that show great promise, there are lots of questions that remain essential in the management of postoperative pain after surgery of the lumbar spine. These include how these two interventions may affect patients of different surgical complexities, such as how many levels were included in the operation, intraoperative heart rate, and mean arterial blood pressure. A comparison needs to be done between the two techniques for postoperative pain scores, analgesia requirement, and rescue analgesia. The differences in intraoperative fentanyl and postoperative pethidine use also needed to be brought out between the two techniques. Lastly, knowing the possible complications from nausea and vomiting is essential. These findings build on the knowledge of the relative effectiveness and safety of caudal block and QLB for postoperative pain after lumbar spine surgery. Nevertheless, more studies will be required to establish the long-term effects of both techniques, determine the ideal candidates for these procedures, and comparisons with other methods for pain management.

This study compares the analgesic efficacy and safety of quadratus lumborum plane block to caudal block guided by ultrasonography for patients having lumbar spine stabilization procedures.

The aim, design and setting of the study

This double-blinded prospective comparative study was conducted at Fayoum University Hospital with approval from the ethics committee, the local institutional board, and approval number M696 from the ethical committee. This trial is randomized, double-blind, and controlled. Qualified patients signed a thorough informed consent form before recruitment and randomization.

Criteria for inclusion

Adult patients of either gender between the ages of 18 and 60 who are having elective lumbar spine fixation surgery

People are classified as having physical status I–II by the American Society of Anesthesiologists (ASA).

Criteria for exclusion:

Individuals who decline.
Individuals shouldn't have regional anaesthetic due to certain conditions (such as faulty coagulation or local infection at the injection site).
Individuals who have had prior lumbar disc operations or spinal abnormalities.
Drug misuse, mental illnesses, and allergies to local anaesthetics.
A BMI higher than 35

Procedure

Based on the sample size, three parallel groups were randomly assigned to patients. Each consists of 37 patients. For every study patient, a computer-generated random numbering scheme was used to achieve randomization. An anaesthesia resident, blind to the study, utilized and opened opaque sealed envelopes in the operating room. The study group was concealed from the patient and the researcher who gathered the data following the block. An experienced anesthesiologist who was blind to the group assignment assessed every study result. Three patient groups were randomized at random: Group QL received a posterior quadratus lumborum plane block, Group D received a caudal block, and Group C did not receive any blocks.

Prior to Surgery

A preoperative visit was undertaken to get the patient's medical history, do a clinical assessment, provide reassurance, and explain the anaesthetic technique. Patients received an explanation of the study procedure, which included the quadratus lumborum plane block, the NPRS score, and the caudal block, during preanesthetic counselling. The patient's back was examined to check for any anomalies related to the spine. Patients fasted four hours for non-clear liquids, two hours for clear liquids, and six to eight hours for solid meals prior to surgery (16).

Management Within the operation

The patients were connected to several monitoring devices, including pulse oximetry, non-invasive blood pressure monitoring, five-lead electrocardiogram, and capnography. IV access was established. Following five minutes of 100% oxygen preoxygenation, general anaesthesia was administered to the patients in all three groups. Anesthesia was induced intravenously with a combination of propofol (2 mg/kg), fentanyl (1 mcg/kg), and atracurium (0.5 mg/kg). Atracurium (0.1 mg/kg every 20 minutes) and isoflurane (1.2–1.5%) in an oxygen-air mixture were utilized to maintain anaesthesia after oral endotracheal intubation.

Block Method

When the patient's hemodynamics had stabilized, the aseptic preparation of the injection site was finished before the skin incision, and the caudal block or quadratus lumborum plane block was performed in the prone position.

The Caudal Block

For most caudal epidural injections, a linear transducer operating at 7–13 MHz was adequate; however, individuals who were obese needed a curved transducer operating at 2–5 MHz. The ultrasound transducer (LOGIQ P7) was first placed transversely on the midline to get a transverse image of the sacral hiatus. There were two hyperechoic band structures that appeared to be hyperechoic structures between the two sacral cornua. The superficial structure was the sacrococcygeal ligament (SCL), while the deep structure was the dorsal surface of the sacrum. The sacral gap, a hypoechoic region, lies between these two band-like hyperechoic formations (17). At this time, the ultrasonography probe was rotated 90 degrees to acquire a longitudinal image of the sacral hiatus. The block needle was positioned in the longitudinal view using the in-plane technique. It was feasible to visualize the needle puncturing the SCL and entering the hiatus in real-time, but it was not visible past the apex of the hiatus. To avoid puncturing the dura mater, the needle's extension beyond the sacral hiatus was limited to 5 mm because there might be less than 6 mm separating the tip of the dural sac from the tip of the sacral hiatus (18). After the needle was inserted into the caudal canal, 20 millilitres of bupivacaine 0.25% were given. Empirical research has demonstrated that the presence of unidirectional flow, identified by the dominant colour on colour Doppler imaging in the longitudinal view of the sacral hiatus during injection, is indicative of both identical therapeutic goals and an efficacious caudal injection (19, 20).

Block of the Quadratus Lumborum Plane

While the patient was in the prone position and aseptic, a sterile convex probe was placed in a transverse view at the triangle of Petit, which is situated between the iliac crest and the costal border and is where the transversus abdominis muscle is located. The transducer was then pushed posteriorly until the quadratus lumborum (QL) muscle and the middle thoracolumbar fascia were identified close to the posterior aponeurosis of the transversus abdominis muscle (21, 22). The intended needle path was advanced in-plane until the needle tip was discernible between the middle thoracolumbar fascia and the QL muscle (23). 20 millilitres of 0.25% bupivacaine were injected into this plane after aspiration, and two to three millilitres of saline were used to establish the needle's position. The injection was confirmed using hydro dissection. The same dosage was utilized to treat the other side in order to achieve a bilateral block.

Upkeep and Recuperation

A dose of 0.5 mcg/kg of fentanyl was administered to address insufficient analgesia. It was defined as a mean arterial blood pressure or heart rate increase of more than 20% from baseline. The total quantity of IV fentanyl delivered was recorded. Each patient got an intravenous dose of 1 g of paracetamol and 4 mg of ondansetron thirty minutes before the procedure's finish. To reverse muscle relaxation, all patients were given neostigmine (0.05 mg/kg) and atropine (0.01 mg/kg) after surgery. After being sedated, patients were brought to the recovery room, where vital signs, including mean arterial blood pressure, heart rate, respiration rate, and oxygen saturation, were measured. The quality of analgesia was assessed using the numerical pain rating scale (NPRS) at the time of admission to the recovery room and one, two, four, six, eight, twelve, eighteen, and twenty-four hours following surgery. Pethidine at a dose of 0.5 mg/kg was used as rescue analgesia for moderate-to-severe pain (NPRS ≥ 4). The time it took to get the first request for rescue analgesia was observed. Weakness, numbness, and any other neurological abnormalities were noted, along with any intraoperative or postoperative problems such as hypotension, nausea, vomiting, and toxicity from local anaesthetics. Operational time was also recorded.

Primary Outcome Measures:

Time of first rescue analgesia.

Secondary Outcome Measures:

The first 24 hours of pain were measured using the Numerical Pain Rating Scale (NPRS), which has values ranging from 0 (no pain) to 10 (severe pain), with mild pain being classed as 1–3, moderate pain as 4–6, and severe pain as 7–10.Total opioid intake recorded within the first 24 hours.
Amount of fentanyl used during the surgical procedure.
Intraoperative hemodynamic data is collected every 30 minutes.
Postoperative hemodynamic measurements are taken every 2 hours for 24 hours.
Occurrence of complications such as toxicity from local anaesthetics, nausea, and vomiting.
Time taken to complete the surgical procedure.

Statistical Analysis and Sample Size Estimation:

G*Power Prior to the study's implementation, 3.1.9.6 was utilized to calculate the appropriate sample size for a fair distribution among the groups. Data from the Ipek et al. study, which revealed a mean difference of 2.89 in the time to first analgesia (our primary outcome) and standard deviations of 1.94 and 5.71 for their study groups, were used to calculate an effect size of 0.68. For each group, a minimum of 35 patients were required, with an allocation ratio of 1:1, a power (1 – β) of 0.80, and a significance threshold (α) of 0.05. The trial's design called for 37 patients in each group due to the possibility of some participants being excluded (24).

The statistical analysis was conducted using IBM SPSS Statistics 22 (IBM Corp., Armonk, NY, USA). The normality of the data was assessed using the Shapiro-Wilk and Kolmogorov-Smirnov tests. The mean and standard deviation were used as descriptive statistics for numerical variables that were regularly distributed; the median and interquartile range (25th to 75th percentiles) were used for numerical data that were not normally distributed. Chi-square tests were employed to assess the relationships between category variables. One-way analysis of variance (ANOVA) was used for numerical data that had a normal distribution; the Kruskal-Wallis test was used for data that did not. A p-value of less than 0.05 was used to determine a statistically significant result. To account for multiple comparisons, the post hoc Bonferroni correction was used when there were significant values between groups.

	Control group (n = 37)		Quadratus lumborum group (n = 37)		Caudal group (n = 37)		p-value‡
	Median	IQR (25th -75th percentile)	Median	IQR (25th -75th percentile)	Median	IQR (25th -75th percentile)	p-value‡
Time of first rescue analgesic dose (hours)	1 ^a	1.5 (0-1.5)	15 ^b	3.5 (11.5–15)	5 ^C	2.75 (3.25-6)	< 0.001*
First analgesic pethidine dose (mg)	40 ^a	20 (30–50)	30 ^b	12.5 (27.5–40)	30 ^b	10 (30–40)	< 0.001*
24 hours total postoperative pethidine consumption (mg)	150 ^a	70 (90–160)	50 ^b	20 (40–60)	80 ^C	40 (60–100)	< 0.001*

Table (1): Comparison of time and doses of analgesic requirements between three groups

IQR: Interquartile range, ‡: Kruskal-Wallis test, *: p-value < 0.05

According to the post hoc Bonferroni test, homogenous groups have the symbol (a, b, c).

This table illustrates that there is a statistical significance between the three study groups regarding the time of first rescue analgesic dose, first analgesic pethidine dose and 24 hours total postoperative pethidine consumption as p-values were < 0.05 in all these variables between the three study groups.

Table (2): Numeric pain rating scale comparison among the three study groups

Postoperative timepoint	Control group (n = 37)		Quadratus Lumborum group (n = 37)		Caudal group (n = 37)		p-value‡
Postoperative timepoint	Median	IQR (25th -75th percentile)	Median	IQR (25th -75th percentile)	Median	IQR (25th -75th percentile)	p-value‡
After 30 minutes	3	3 (2–5)	0	1 (0–1)	1	2 (0–2)	< 0.001*
1 hour postoperative	2	1.5 (2-3.5)	1	1 (0–1)	1	1 (1–2)	< 0.001*
2 hours postoperative	2	1 (2–3)	1	1 (1–2)	2	1 (1–2)	< 0.001*
4 hours postoperative	3	1 (2–3)	2	1 (1–2)	2	1 (2–3)	< 0.001*
8 hours postoperative	3	3 (2.5–5.5)	2	1 (2–3)	2	1 (2–3)	< 0.001*
12 hours postoperative	3	3 (2–5)	3	1 (2–3)	3	2.5 (2-4.5)	0.225
18 hours postoperative	3	2.5 (2.5-5)	3	2 (2–4)	4	3 (2–5)	0.124
24 hours postoperative	5	3 (3–6)	2	2 (2–4)	3	3 (2–5)	< 0.001*
IQR: Interquartile range, ‡: Kruskal- Walli s test, *: p-value < 0.05

Homogenous groups are (a, b, c) by post hoc Bonferroni test.

This table shows that there is a statistical significance between the three study groups regarding the numeric pain rating scale throughout the postoperative period, as p-values were < 0.05 in all recorded times except after 12 hours and 18 hours, in which the p-value was > 0.05

Table (3): Additional intraoperative fentanyl dose comparison between the three study groups

	Control group (n = 37)		Quadratus Lumborum group (n = 37)		Caudal group (n = 37)		p-value‡
	Median	IQR (25th -75th percentile)	Median	IQR (25th -75th percentile)	Median	IQR (25th -75th percentile)
Additional intraoperative fentanyl dose (microgram)	50 ^a	100 (0-100)	0 ^b	0 (0–0)	0 ^b	0 (0–0)	< 0.001*
IQR: Interquartile range, ‡: Kruskal-Wallis test, *: p-value < 0.05

Homogenous groups had the symbol (a, b, c) by post hoc Bonferroni test.

This table illustrates that there is a statistical significance between the three study groups regarding additional intraoperative fentanyl dose as p-values were < 0.05

Table (4): Comparison of occurrence of complications between three groups

	Control group (n = 37)		Quadratus Lumborum group (n = 37)				Caudal group (n = 37)		p-value#
	Number	Percentage	Number	Percentage			Number	Percentage	p-value#
Nausea No Yes	37 0	100% 0%	36 1			97% 3%	37 0	100% 0%	0.365
Vomiting No Yes	37 0	100% 0%	36 1		97% 3%		37 0	100% 0%	0.365
#: Chi-square test

This table shows that there is a non-statistical significance between the three study groups regarding the occurrence of complications, as the p-value was > 0.05

Figure (2): Multiple Line chart for intraoperative mean arterial blood pressure at different time points for the three study groups.

In the context of lumbar spine surgery, there has been considerable investigation into diverse regional anaesthesia techniques aimed at delivering effective and prolonged postoperative analgesia. Regional anaesthesia, which involves the selective blockade of specific nerve regions, has emerged as a critical component in the management of postoperative pain, influencing both the efficacy of pain control and patient recovery (27–29). Various techniques, including but not limited to caudal blocks, epidural analgesia, and peripheral nerve blocks, have been assessed for their ability to optimize pain relief, minimize opioid consumption, and enhance overall surgical outcomes. Each technique offers distinct advantages and limitations, which are subject to ongoing evaluation and comparison in clinical studies. This research is pivotal in refining pain management protocols and improving patient experiences in the postoperative period following lumbar spine procedures (10, 25–27).

Ultrasound (US)-guided regional anaesthesia has gained prominence due to its precision and effectiveness (28). US guidance enhances the accuracy of neural structure targeting, improving drug delivery and reducing complications (28). These methods offer significant potential for optimizing postoperative pain management by providing reliable and sustained analgesia, which may reduce the need for systemic analgesics and enhance recovery (28).

Klocke et al. (2003) initially introduced the ultrasound-guided caudal block, which is a unique technique among US-guided regional anaesthesia methods. This method leverages ultrasound imaging to enhance the precision of needle placement and drug delivery into the caudal epidural space. By improving the visualization of anatomical landmarks, this technique aims to optimize analgesic outcomes and minimize procedural risks (29). The majority of research that has been published up to this point outlines methods for performing particular blocks under ultrasound direction (17, 20, 30). This type of research, although important, merely demonstrates that a block can be done with ultrasound guidance and in no way constitutes proof that the block confers more value to a patient than without the use of ultrasound.

While the caudal block is a frequently used regional anaesthetic procedure for pediatric patients, its suitability for adult patients is still being studied (31). Although the caudal block is a useful analgesic, there is a chance that it can cause neurological problems, which is why other analgesic techniques are being investigated (32). The quadratus lumborum plane block (QLB), a posterior abdominal wall fascial plane block initially described by Blanco in 2007, is a relatively new method (34). Several investigations have demonstrated the efficiency of QLB in controlling postoperative pain, supporting its usefulness for postoperative analgesia (35).

The role of effective postoperative pain management in enhancing patient outcomes, particularly in terms of early mobilization and reduced opioid use, has been well-documented in several studies. For instance, In single-level lumbar decompression procedures, Saoud et al. (36) showed that pre-emptive caudal bupivacaine morphine considerably extended the duration of postoperative analgesia, hence decreasing the requirement for intraoperative and postoperative NSAIDs and pethidine. This strategy demonstrated its efficacy in accelerating recuperation and decreasing dependency on supplementary analgesics by enabling faster patient ambulation without causing any appreciable hemodynamic instability or an increase in the frequency of side effects.

Similarly, SERTCAKACILAR et al. (37) reported that patients who underwent (QLB) for postoperative analgesia experienced lower opioid consumption and pain levels in the first 24 hours post-surgery. Notably, the QL block was associated with improved early mobilization and reduced hospital stays, both of which are crucial for cost reduction and faster recovery. However, they observed that opioid consumption in the QLB group increased towards the 24th hour, likely due to the diminishing effect of the long-acting local anaesthetics used. These findings emphasize the importance of selecting appropriate analgesic strategies that provide sustained pain relief to maximize patient outcomes in the postoperative period.

Regarding the demographic data of the study participants across the three groups. The distribution of sex was comparable among the groups: the control group included 18 males (49%) and 19 females (51%), the quadratus lumborum group had 19 males (51%) and 18 females (49%), and the caudal group comprised 20 males (54%) and 17 females (46%), with no statistically significant difference observed (p = 0.897). Regarding age, the mean was 45.5 years in the control group, 43.6 years in the quadratus lumborum group, and 42.5 years in the caudal group, with no significant differences (p = 0.432). The mean BMI values were 31.5 kg/m² for the control group, 31.1 kg/m² for the quadratus lumborum group, and 31.4 kg/m² for the caudal group, also showing no significant differences (p = 0.584).

Regarding the surgical conditions across the three study groups. The distribution of the number of surgical levels was similar among the groups: in the control group, 0 patients had 1 level, 26 patients had 2 levels (70%), and 11 patients had 3 levels (30%). In the quadratus lumborum group, 6 patients had 1 level (16%), 18 had 2 levels (49%), and 13 had 3 levels (35%). In the caudal group, 5 patients had 1 level (13%), 21 had 2 levels (57%), and 11 had 3 levels (30%). The p-value for this comparison was 0.117, indicating no statistically significant difference. Operative times were also comparable across groups: With an interquartile range of 45 minutes for the control group, 30 minutes for the quadratus lumborum group, and 60 minutes for the caudal group, the median operational time was 180 minutes for all groups. The p-value was 0.815. This study demonstrates that there were no significant differences in surgical circumstances, such as the number of surgical levels or operating time, across the groups, indicating that changes in surgical conditions are unlikely to have an impact on the observed outcomes.

It is important to recognize the limits that the study has to offer. Because the study was limited to one facility, it's possible that the conclusions cannot be applied to other hospitals or areas with distinct operating procedures. Furthermore, the study mainly examines short-term results, omitting to investigate the long-term implications on pain management and patient rehabilitation. As the blocks were given after the induction of anaesthesia, a dermatomal examination after the procedure was not feasible. Furthermore, because the assessment of pain ratings was limited to the resting state, assessments of dynamic pain should be included in future research to provide a more thorough analysis.

Despite these limitations, the study has several notable strengths. Its robust design and methodology, including a randomized, double-blind, controlled approach, enhance the reliability and validity of the findings. This study is one of the first to statistically compare quadratus lumborum (QL) blocks with caudal blocks in adult patients undergoing lumbar spine surgery. The comprehensive procedural descriptions and the use of objective measures, such as pain scores and opioid consumption, further strengthen the reliability of the results. The thorough statistical analysis ensures that the conclusions drawn are both valid and significant, laying a strong foundation for future research. Further investigations, particularly larger studies, are needed to validate these findings and to explore the integration of both techniques into multimodal analgesia protocols. Additionally, assessing postoperative patient satisfaction and quality of recovery in future studies will provide a more comprehensive evaluation of the analgesic techniques.

Postoperative analgesia for patients undergoing lumbar spine fixation can be safely and effectively achieved with both ultrasound-guided caudal block and QL block. The caudal block demonstrated superior analgesic efficacy and hemodynamic stability compared to the control group intraoperatively, while the QL block was associated with significantly lower postoperative opioid consumption. These findings suggest that both regional anaesthesia techniques offer effective alternatives to standard care, with the QLP block providing extended pain relief.

Abbreviation	Meaning
ASA	American Society of Anesthesiologists
BMI	Body Mass Index
IQR	Interquartile Range
NPRS	Numerical Pain Rating Scale
QLP	Quadratus Lumborum Plane
SCL	Sacrococcygeal Ligament
US	Ultrasound
vs	versus (meaning "against" or "compared to")
μg	Microgram
mg	Milligram
ml	Milliliter
h	Hour
min	Minute
cm	Centimeter
MHz	Megahertz
IV	Intravenous
RCT	Randomized Controlled Trial
PONV	Postoperative Nausea and Vomiting

Ethics approval and consent to participate and Consent for publication: This study was conducted at Fayoum University Hospital with approval from the ethics committee, the local institutional board, and approval number M696 from the ethical committee. This trial is randomized, double-blind, and controlled. Qualified patients signed a thorough informed consent form before recruitment and randomization.

Availability of data and materials: All data are available with the corrosponding author on resonable request.

Competing interests: None

Funding: None

Consent for publication: Not applicable

Acknowledgements: Not applicable did not meet the criteria for authorship.

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No competing interests reported.

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Analgesic Effect of Ultrasound-Guided Caudal Block Versus Quadratus Lumborum Plane Block in Lumbar Spine Surgery in Adult Patients: A Double-Blinded Prospective Comparative Study

Status:

Version 1

Abstract

Background

Methods

Results

Conclusions

Trial registration:

Figures

Background

Methods

The aim, design and setting of the study

Procedure

Prior to Surgery

Management Within the operation

Block Method

The Caudal Block

Block of the Quadratus Lumborum Plane

Upkeep and Recuperation

Primary Outcome Measures:

Secondary Outcome Measures:

Statistical Analysis and Sample Size Estimation:

Results

Discussion

Conclusion

Abbreviations

Declarations

References

Additional Declarations

Status:

Version 1