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In children undergoing umbilical hernia repair is rectus sheath block effective at reducing post-operative pain? Best
Kapil M Rajwani1, Sarah Butler2, Anies Mahomed1
1Department of Paediatric Surgery, Royal Alexandra Children's Hospital, Eastern Road, Brighton BN2 5BE, UK.
Insights
Rectus sheath block (RSB) offers better pain relief after pediatric umbilical hernia repair compared to local anesthetic infiltration. This technique may reduce the need for opioids, but requires careful consideration of associated resources and risks.
Area of Science:
- Pediatric Surgery
- Pain Management
- Anesthesiology
Background:
- Umbilical hernia repair is a common pediatric surgical procedure.
- Effective post-operative pain management is crucial for patient recovery and satisfaction.
- Current pain management strategies include local anesthetic infiltration and regional blocks.
Purpose of the Study:
- To evaluate the efficacy of rectus sheath block (RSB) compared to local anesthetic infiltration for post-operative pain control in children undergoing umbilical hernia repair.
- To determine if RSB reduces the need for opioid analgesia in the post-operative period.
Main Methods:
- A systematic review of the best available evidence was conducted.
- Three studies, including randomized clinical trials, were analyzed to compare RSB with local anesthetic infiltration.
- Outcomes assessed included post-operative pain scores and opioid consumption.
Main Results:
- One randomized clinical trial indicated that RSB provided superior analgesia in the immediate post-operative phase.
- Another randomized trial demonstrated significantly lower peri-operative opioid consumption in patients who received RSB.
- These findings suggest a potential benefit of RSB in reducing pain and opioid requirements.
Conclusions:
- Rectus sheath block (RSB) appears to be more effective than local anesthetic infiltration for managing post-operative pain in pediatric umbilical hernia repair.
- The benefits of RSB in pain reduction and decreased opioid use must be weighed against the technical expertise, training, equipment, time, and potential complications associated with its administration.
Abstract:
A best evidence topic was constructed according to a structured protocol. The question addressed was: In children undergoing umbilical hernia repair is a rectus sheath block (RSB) better than local anaesthetic infiltration of the surgical site, at reducing post-operative pain? From a total of 34 papers, three studies provided the best available evidence on this topic. One randomised clinical trial showed RSB had a better analgesic effect in the immediate post-operative period. In another randomised trial opioid consumption in the peri-operative period was found to be significantly lower in patients administered RSB. These improvements in pain and analgesia consumption need to be balanced against the expertise, training, equipment required, time implications and complications of performing a RSB.
