Faculty Collaboration Database

Percutaneous ultrasound-guided vs. intraoperative rectus sheath block for pediatric umbilical hernia repair: A randomized clinical trial. J Pediatr Surg 2017 Jun;52(6):901-906

Date

04/06/2017

Pubmed ID

28377023

DOI

10.1016/j.jpedsurg.2017.03.007

Scopus ID

2-s2.0-85016411891 (requires institutional sign-in at Scopus site)   13 Citations

Abstract

BACKGROUND: Regional anesthesia is commonly used in children. Our hypothesis was that percutaneous ultrasound-guided (PERC) rectus sheath blocks would result in lower postoperative pain scores compared to intraoperative (IO) rectus sheath blocks following umbilical hernia repair.

METHODS: A single-institution randomized blinded trial was conducted in pediatric patients undergoing elective umbilical hernia repair. The primary outcome was mean postoperative Wong-Baker pain score. Secondary outcomes included narcotic requirements and length of postoperative stay.

RESULTS: Fifty-eight patients were included: 28 PERC and 30 IO. Operating room time was significantly longer in the PERC group (41 vs. 35min, p<0.01). Mean postoperative pain scores (PERC-2.6 vs. IO-3.3, p=0.11), morphine equivalents intraoperatively (PERC-0 vs. IO-0.04mg/kg, p=0.29) and postoperatively (PERC-0.04 vs. IO-0.09mg/kg, p=0.17), time to first postoperative narcotic dose (PERC-30 vs. IO-22min, p=0.33, log-rank test), and postoperative length of stay (PERC-76 vs. IO-80min, p=0.44) were similar.

CONCLUSION: Following umbilical hernia repair in children, percutaneous ultrasound-guided and intraoperative rectus sheath blocks resulted in similar mean postoperative pain scores. There were no differences in secondary outcomes such as time to first narcotic, narcotic requirements, and length of stay. The additional resources required to complete a percutaneous ultrasound-guided rectus sheath block may not be warranted.

TYPE OF STUDY: Randomized controlled trial.

LEVEL OF EVIDENCE: Level I.

Author List

Litz CN, Farach SM, Fernandez AM, Elliott R, Dolan J, Patel N, Zamora L, Colombani PM, Walford NE, Amankwah EK, Snyder CW, Danielson PD, Chandler NM

Author

Ernest Amankwah PhD Director, Associate Professor in the Clinical and Translational Science Institute department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Child
Child, Preschool
Double-Blind Method
Female
Hernia, Umbilical
Humans
Intraoperative Care
Male
Nerve Block
Pain Measurement
Pain, Postoperative
Prospective Studies
Rectus Abdominis
Treatment Outcome
Ultrasonography, Interventional