Liposomal Bupivacaine in Single-Injection Quadratus Lumborum Block for Pediatric Kidney Transplant: Case Report of a Novel Application.

Background: Liposomal bupivacaine is FDA-approved long-acting bupivacaine for intraoperative local wound infiltration in pediatric patients 6 years and older, but not for ultrasound-guided peripheral nerve blocks. There are few prior reports of using liposomal bupivacaine for preoperative peripheral nerve blocks in pediatric patients. We report the first use of liposomal bupivacaine in a single-injection quadratus lumborum block in a pediatric patient undergoing a kidney transplant.

Methods: Our patient is a 16-year-old female undergoing a living-related kidney transplant for end-stage renal disease. Pertinent past medical history includes symptoms of opioid withdrawal during a prior hospitalization. To optimize postoperative pain control, a preoperative single injection quadratus lumborum nerve block was performed with liposomal bupivacaine, and opioids and acetaminophen were administered as needed in the perioperative period.

Results: The patient had excellent pain control for the first 36 h postoperatively and adequate pain control for the entire hospital stay, with minimal opioid administration. She reported decreased sensation to temperature and touch over her entire ipsilateral abdomen/flank for the first 48 h. Postoperative day 4 marked her highest average pain score, coinciding with the reported 72 h of efficacy of liposomal bupivacaine. She was able to ambulate less than 24 h postoperatively, did not report any withdrawal symptoms, and had no adverse events.

Conclusions: This is the first documented case of liposomal bupivacaine in a preoperative quadratus lumborum nerve block for a pediatric patient. More studies are required to investigate the pharmacokinetics of liposomal bupivacaine in kidney recipients and determine its efficacy and safety.