Comparison of ESP and QL Blocks for Postoperative Pain in Pediatric Appendectomy (ESP-QLB)

Appendectomy is one of the most common emergency surgical procedures in children, and effective postoperative analgesia plays a key role in patient comfort, early mobilization, and reduced opioid exposure. Regional anesthesia techniques have gained increasing importance in pediatric anesthesia due to their opioid-sparing effect and favorable safety profile. Among these techniques, the Erector Spinae Plane (ESP) block and the Quadratus Lumborum (QL) block have shown promising results; however, there is a lack of high-quality randomized controlled trials directly comparing their clinical efficacy in pediatric appendectomy.

This study will prospectively enroll pediatric patients between 3 and 13 years of age who are scheduled to undergo appendectomy. After obtaining informed parental consent, participants will be randomly allocated to either the ESP block group or the QL block group. All blocks will be performed under ultrasound guidance using 0.25% bupivacaine at a dose of 0.5 mL/kg following the induction of general anesthesia. Standardized postoperative analgesia protocols will be applied to all participants.

Pain scores will be measured at predefined time points using a validated pediatric pain scale. Secondary outcomes will include total opioid consumption during the first 24 hours, the time to first rescue analgesic requirement, mobilization time, length of hospital stay, parental satisfaction scores, and any block-related complications. Patient data will be collected by trained investigators who will be blinded to group allocation.

The goal of this trial is to determine whether ESP or QL block provides superior postoperative pain control and recovery in pediatric appendectomy. The results may contribute to evidence-based recommendations for regional anesthesia selection in pediatric surgical practice.

Inclusion criteria

• Patients aged 3-13 years
• Diagnosis of acute appendicitis requiring appendectomy
• ASA physical status I-II
• Planned general anesthesia with intraoperative regional block (ESP or QL block)
• Written informed consent obtained from parents or legal guardians

Exclusion criteria

• Refusal of regional block by family or anesthesia team
• Coagulopathy or anticoagulant medication use
• Local infection at the block injection site
• Known allergy or contraindication to local anesthetics
• Neurological or neuromuscular disorders
• Cognitive impairment preventing postoperative pain assessment
• Conversion to open surgery
• Intraoperative complications requiring deviation from study protocol