Rectus sheath blocks for pediatric laparoscopic appendicectomy

Acute appendicitis is the leading cause of abdominal surgical emergencies, and appendicectomy is a commonly performed surgery. Although generally regarded as minor, appendicectomies can lead to significant postoperative pain. Rectus sheath blocks (RSB) can provide effective analgesia for 3-port laparoscopic appendicectomy.

A total of 145 patients aged between 8 and 18 years who underwent laparoscopic appendicectomy were included in this prospective observational study. The study cohort was analyzed in two groups: patients who received RSB (RSB group, n = 68) and control patients who did not receive any type of regional blocks (Control group, n = 77). Data on postoperative pain scores, total analgesic consumption, and the cutaneous sensory coverage of RSB in the port entry areas were collected.

Postoperative pain scores at the 3rd hour were significantly lower in the RSB group compared to the controls (p < 0.001). Total paracetamol use in the first 24 h was also reduced in the RSB group (p < 0.001). The need for rescue analgesics was slightly lower in the RSB group (p = 0.047). Total procedural time showed no significant difference between the groups. In the postoperative 3rd hour assessment of the RSB blocks: all patients experienced visceral pain to varying degrees, three (4.4%) had pain at the umbilical port entry site, fourteen (20.6%) had pain at the left iliac fossa port entry site, and eight (11.8%) had pain at the suprapubic port entry site.

RSB can improve pain scores and reduce overall analgesic consumption in pediatric laparoscopic appendicectomies. However, RSB may miss the lateral trocar entry site, and suprapubic coverage can differ among individuals.

NCT06913205.