Rectus sheath blocks for pediatric laparoscopic appendicectomy

Area of Science:

• Pediatric Surgery
• Pain Management
• Regional Anesthesia

Background:

• Acute appendicitis is a common surgical emergency in children.
• Laparoscopic appendicectomy, while common, can result in significant postoperative pain.
• Rectus sheath blocks (RSB) are explored for analgesia in pediatric laparoscopic appendicectomy.

Purpose of the Study:

• To evaluate the efficacy of RSB in managing postoperative pain after pediatric laparoscopic appendicectomy.
• To compare pain scores and analgesic consumption between patients receiving RSB and controls.
• To assess the cutaneous sensory coverage of RSB in port entry areas.

Main Methods:

• A prospective observational study included 145 pediatric patients (8-18 years) undergoing laparoscopic appendicectomy.
• Patients were divided into two groups: RSB group (n=68) and control group (n=77).
• Data collected included postoperative pain scores, analgesic consumption, and RSB sensory coverage.

Main Results:

• RSB group showed significantly lower pain scores at 3 hours post-surgery (p<0.001).
• Total paracetamol use in the first 24 hours was reduced in the RSB group (p<0.001).
• Need for rescue analgesics was slightly lower in the RSB group (p=0.047), with no significant difference in procedural time.

Conclusions:

• RSB effectively improves pain management and reduces analgesic needs in pediatric laparoscopic appendicectomies.
• RSB may have limitations in covering lateral trocar sites and variable suprapubic coverage.
• Further research may be needed to optimize RSB for comprehensive port site analgesia.