Quadratus lumborum block has shown to provide longer and more effective postoperative analgesia compared with the transversus abdominis plane block and caudal block  in children. Dexmedetomidine is a highly selective α2 agonist, with sympatholytic, sedative, anxiolytic and analgesic which acts by decreasing sympathetic central nervous outflow without the systemic side effects of opioids such as nausea, vomiting, respiratory depression, urinary retention, and pruritus. This study aims to evaluate effectiveness of ultrasound guided Quadratus lumborum block with dexmedetomidine as adjuvant in children undergoing Laparoscopic surgeries. The objective of study is to assess the time to first analgesic, postoperative pain scores, need for rescue analgesia, duration of block action and complications related to quadratus lumborum block with dexmedetomidine. 

After obtaining Institution Ethics Committee approval - patient who fit into inclusion criteria will be enrolled into the study after obtaining informed consent from the patient’s guardian. 

Patients will be randomly allocated to two groups by using computer generated random table. 

GROUP A : 0.8 ml/kg of 0.25% bupivacaine for USG - guided Quadratus lumborum block with 1 mcg/kg of dexmedetomidine diluted with appropriate amount of saline 

GROUP B : 0.8 ml/kg of 0.25% bupivacaine for USG – guided Quadratus lumborum block with appropriate amount of saline

Once the patient is wheeled into the holding area, baseline vitals – heart rate, oxygen saturation, blood pressure will be monitored. Block performence time, time from block given to incision, Duration of surgery will be noted down. 

All children under 18 years coming for laparoscopic surgery will be premedicated with midazolam 0.5 mg/kg orally if required. Inhalational induction with Sevoflurane by mask 8% in 6L/min of O2 as FGF, IV secured. Inj. fentanyl 2 mg/kg IV, appropriate size enotracheal intubation will be done and secured after confirming air entry, anesthesia will be maintained with O2 and air and sevoflurane. Patient’s eyes will be adequately padded. Patients in both groups will received bilateral quadratus lumborum block according to the group allocation. Vitals will be monitered intraoperatively. 3 values will be recorded intraoperatively for 10 minutes post port insertion. 15mg/kg body weight Paracetamol will be given intraoperatively 30 minutes before extubation.

Postoperative pain will be assessed by FLACC scale in children upto 7 years and visual analogue scale for children from 7 years to 18 years, Postoperative sedation will be assessed by ramsey sedation score. immediately after extubation and at 5 minutes and 10 minutes post extubation, every 30 min in PACU for 2 hours and every 6 hours till 36 hours. The heart rate, pain scores and oxygen saturation will be monitored. Patients requirement of supplemental analgesic noted. FLACC or VAS Pain score more than 3 - Paracetamol 15mg/kg will be given. in case of incidence of pain within 6 hours of paracetamol, ibuprofen 7mg/kg will be given as rescue analgesic.

Routine postoperative vital data will be taken and the incidence of postoperative complications as hypotension, bradycardia, vomiting, pruritis and respiratory depression (respiratory rate less than 10 breathes/min) will be recorded. 

This study will help us promote better methods of postoperative and intraoperative analgesia and reduce opioid requirements and thereby opioid related complications in pediatric population