Ultrasound-guided bilateral rectus sheath block vs. conventional local analgesia in single port laparoscopic appendectomy for children with non-perforated appendicitis

• Published in: Journal of pediatric surgery 2017
• Main Authors: Maloney, Caroline, Kallis, Michelle, El-Shafy, Ibrahim Abd, Lipskar, Aaron M, Hagen, John, Kars, Michelle
• Format: Article
• Language: English
• Subjects: Pediatrics; Surgery
• ISSN: 0022-3468
• DOI: 10.1016/j.jpedsurg.2017.05.027

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 sameday 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–July 2015. We compared those that received pre-incision 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 pre-incision 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 (58.93 minutes vs. 41.56 minutes; p = 0.047). Conclusion Pre-incision 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 6.67 minutes to time under anesthesia, we feel it is a viable option for postoperative pain control in pediatric single-incision laparoscopic surgery. Retrospective comparative study LEVEL III EVIDENCE.