Faculty Collaboration Database

Ultrasound-guided bilateral rectus sheath block vs. conventional local analgesia in single port laparoscopic appendectomy for children with nonperforated appendicitis. J Pediatr Surg 2018 Mar;53(3):431-436

Date

06/15/2017

Pubmed ID

28610706

DOI

10.1016/j.jpedsurg.2017.05.027

Scopus ID

2-s2.0-85020447925 (requires institutional sign-in at Scopus site)   23 Citations

Abstract

INTRODUCTION: Despite its minimally invasive approach, laparoscopic surgery can cause considerable pain. Regional analgesic techniques such as the rectus sheath block (RSB) offer improved pain management following elective umbilical hernia repair in the pediatric population. This effect has not been examined in laparoscopic single-incision surgery in children. We sought to compare the efficacy of bilateral ultrasound-guided RSB versus local anesthetic infiltration (LAI) in providing postoperative pain relief in pediatric single-incision transumbilical laparoscopic assisted appendectomy (TULA) with same-day discharge.

METHODS: We retrospectively reviewed 275 children, ages 4 to 17 years old, who underwent TULA for uncomplicated appendicitis in a single institution from August 2014 to July 2015. We compared those that received preincision bilateral RSB (n=136) with those who received LAI (n=139). The primary outcome was narcotic administration. Secondary outcomes included initial and mean scores, time from anesthesia induction to release, operative time, time to rescue dose of analgesic in the PACU and time to PACU discharge.

RESULTS: Total narcotic administration was significantly reduced in patients that underwent preincision RSB compared to those that received conventional LAI, with a mean of 0.112 mg/kg of morphine versus 0.290 mg/kg morphine (p<0.0001). Patients undergoing RSB reported lower initial (0.38 vs. 2.38; p<0.0001) and mean pain scores (1.26 vs. 1.77; p<0.015). Time to rescue analgesia was prolonged in patients undergoing RSB compared to LAI (58.93min vs. 41.56min; p=0.047).

CONCLUSION: Preincision RSB for TULA in uncomplicated appendicitis in children is associated with decreased opioid consumption and lower pain scores compared with LAI. As the addition of this procedure only added 6.67min to time under anesthesia, we feel that it is a viable option for postoperative pain control in pediatric single-incision laparoscopic surgery.

RETROSPECTIVE COMPARATIVE STUDY: LEVEL III EVIDENCE.

Author List

Maloney C, Kallis M, El-Shafy IA, Lipskar AM, Hagen J, Kars M

Author

Caroline Maloney MD, PhD Assistant Professor in the Surgery department at Medical College of Wisconsin

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

Adolescent
Analgesics, Opioid
Anesthesia, Local
Appendectomy
Appendicitis
Child
Child, Preschool
Female
Humans
Laparoscopy
Male
Morphine
Nerve Block
Pain Measurement
Pain, Postoperative
Rectus Abdominis
Retrospective Studies
Treatment Outcome
Ultrasonography, Interventional