Abstract
BACKGROUND: Effective postoperative analgesia for pediatric developmental dysplasia of the hip (DDH) surgery remains a challenge. This study aimed to compare the analgesic efficacy of a combined fascia iliaca compartment block (FICB) and quadratus lumborum block (QLB) versus patient-controlled intravenous analgesia (PCIA) in pediatric patients undergoing open reduction surgery for DDH under general anesthesia. METHODS: This retrospective cohort study enrolled children under 16 years old undergoing DDH surgery between January 2016 and January 2024. Patients were divided into two groups based on the analgesia received: a Block group (FICB + QLB, n = 35) and a PCIA group (n = 35). The primary outcome was postoperative pain assessed by the FLACC score at 1 and 24 h. Secondary outcomes included 24-hour opioid (fentanyl) consumption, frequency of rescue non-steroidal anti-inflammatory drug (NSAID) use, and parental satisfaction. RESULTS: The study included 35 patients in the PCIA group and 35 in the block group. FLACC pain scores were significantly lower in the Block group at both 1 h (median: 3 vs. 7, p < 0.001) and 24 h postoperatively (median: 2 vs. 5, p < 0.001). Total opioid consumption was markedly lower in the Block group (mean: 5.97 vs. 20.66 µg/kg, p < 0.001), as was the need for rescue NSAIDs (median administrations: 2 vs. 4, p < 0.001). Parental satisfaction was significantly higher in the Block group (p < 0.001). CONCLUSION: The combination of FICB and QLB provides superior postoperative analgesia compared to PCIA alone in children undergoing DDH surgery, significantly reducing pain scores, opioid requirements, and rescue analgesic need, while leading to higher parental satisfaction. CLINICAL TRIAL NUMBER: Not applicable.