Rectus sheath block for laparoscopic appendicectomy: a randomized clinical trial

• Published in: ANZ journal of surgery 2015-12, Vol.85 (12), p.951-956
• Main Authors: Hamill, James K., Liley, Andrew, Hill, Andrew G.
• Format: Article
• Language: English
• Subjects: Adolescent; analgesia; Analgesics, Opioid - administration & dosage; Anesthetics, Local - administration & dosage; appendectomy; Appendectomy - methods; Appendicitis; Appendicitis - surgery; Bupivacaine - administration & dosage; Child; Clinical trials; Double-Blind Method; Female; Humans; Laparoscopy; Laparoscopy - methods; Length of Stay - statistics & numerical data; Male; Narcotics; nerve block; Nerve Block - methods; Pain management; Pain, Postoperative - drug therapy; Pain, Postoperative - prevention & control; Pediatrics; Treatment Outcome
• ISSN: 1445-1433; 1445-2197
• DOI: 10.1111/ans.12950

Background The rectus sheath block is effective in elective paediatric operations, but has not been previously studied in acute laparoscopic surgery. We investigated its effect on pain after laparoscopic appendicectomy for acute appendicitis. Methods Children aged 8–14 years admitted to a paediatric teaching hospital participated in a randomized clinical trial comparing a rectus sheath block using bupivacaine plus adrenaline with saline control. The primary outcomes were pain scores and opiate use, and secondary outcomes were time in the post‐anaesthetic care unit, duration of hospitalization and recovery. Results Children in the nerve block group reported significantly reduced global pain scores compared with controls in the first 3 h after surgery, estimated mean 2.22 versus 3.94, effect size −1.80 (P = .008). Pain scores after 3 h did not differ between the groups. The groups did not differ in opiate requirements, length of hospital stay or recovery after discharge. Conclusions In children undergoing acute laparoscopic appendicectomy, a rectus sheath block reduced early post‐operative pain, and could contribute to a multimodal recovery programme.