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A pilot study of the rectus sheath block for pain control after umbilical hernia repair
Lisa A Isaac1, Judith McEwen, Jason A Hayes
1Department of Anesthesia, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
Insights
The rectus sheath block did not offer better pain relief than local anesthetic infiltration for children undergoing umbilical hernia repair. Both methods provided similar pain control and safety outcomes post-surgery.
Area of Science:
- Pediatric surgery
- Pain management
- Anesthesiology
Background:
- Umbilical hernia repair is a common pediatric surgery with significant postoperative pain.
- The rectus sheath block is a potential method for improving pain control after this procedure.
- This study evaluated its efficacy against standard local anesthetic infiltration.
Purpose of the Study:
- To compare the effectiveness of rectus sheath block versus local anesthetic infiltration for pain management in children after umbilical hernia repair.
Main Methods:
- A pilot study involving 14 children (aged 1-8 years) randomly assigned to either rectus sheath block or local infiltration.
- Both groups received 0.25% bupivacaine with epinephrine.
- Postoperative pain (CHEOPS scores), sedation, and morphine use were assessed by a blinded investigator.
Main Results:
- No significant difference in total postoperative morphine consumption between the rectus sheath block and local infiltration groups.
- Similar pain and sedation scores were observed in both groups.
- No complications were reported for either analgesic technique.
Conclusions:
- The rectus sheath block showed no significant advantage over local anesthetic infiltration for postoperative pain management in pediatric umbilical hernia repair.
- Both techniques were equally effective and safe in this pilot study.
Background:
Umbilical hernia repair, a common day surgery procedure in children, is associated with significant postoperative discomfort. The rectus sheath block may offer improved pain management following umbilical hernia repair. In this pilot study, we compared the efficacy of the rectus sheath block with that of our current standard practice--local anesthetic infiltration into the surgical wound--for pain control after umbilical hernia repair in children.
Methods:
Fourteen children, aged 1-8 years, undergoing umbilical hernia repair were randomly assigned to receive either a rectus sheath block or local anesthetic infiltration into the surgical wound at completion of surgery. Anesthetic management was standardized. Each analgesic technique was performed using 0.8 ml x kg(-1) of 0.25% bupivacaine with epinephrine 1:200,000. Postoperatively, an investigator who was blinded to the analgesic technique recorded the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) scores and sedation scores every 10 min, and administered intravenous morphine 50 microg x kg(-1) for cases with CHEOPS scores > or = 8. Total morphine dose was recorded. Parents were telephoned the day after surgery to determine the overall satisfaction with pain control.
Results:
Total postoperative morphine consumption did not differ significantly between groups, averaging 0.10 +/- 0.09 and 0.10 +/- 0.07 mg x kg(-1) for the local infiltration and rectus sheath groups, respectively. There were no significant differences in pain or sedation scores, and no complications related to either analgesic technique.
Discussion:
Our results suggest that the rectus sheath block has no advantage over infiltration of local anesthetic into the surgical wound for postoperative pain management in children undergoing umbilical hernia repair.
