title: Ultrasonography-guided bilateral rectus sheath block vs local anesthetic infiltration after pediatric umbilical hernia repair: a prospective randomized clinical trial.
abstract: OBJECTIVE
  Regional anesthetic techniques can be used to alleviate postoperative pain in children undergoing pediatric surgical procedures. Use of ultrasonographic guidance for bilateral rectus sheath block (BRSB) has been shown to improve immediate pain scores and reduce use of postoperative analgesia in the postanesthesia care unit (PACU).
  
  
  OBJECTIVE
  To compare efficacy of ultrasonography-guided BRSB and local anesthetic infiltration (LAI) in providing postoperative analgesia after pediatric umbilical hernia repair.
  
  
  METHODS
  Prospective, observer-blinded, randomized clinical trial.
  
  
  METHODS
  Tertiary-referral urban children's hospital.
  
  
  METHODS
  Eligible children 3 to 12 years of age undergoing elective umbilical hernia repair from November 16, 2009, through May 31, 2011.
  
  
  METHODS
  Ropivacaine hydrochloride administered at the conclusion of surgery as LAI by the surgeon (n = 25) or as ultrasonography-guided BRSB by the anesthesiologist (n = 27).
  
  
  METHODS
  Scores on the FACES Pain Rating Scale measured at 10-minute intervals and all use of analgesic medications in the PACU.
  
  
  RESULTS
  Median FACES scores in the PACU were lower in the BRSB group compared with the LAI group at 10 minutes (0 vs 1; P = .04), 30 minutes (0 vs 1; P = .01), and 40 minutes or later (0 vs 1; P = .03). Fewer doses of opioid and nonopioid medications were given to the BRSB group compared with the LAI group (5 vs 11 doses for opioids; 5 vs 10 for nonopioids).
  
  
  CONCLUSIONS
  In the PACU, ultrasonography-guided BRSB after umbilical hernia repair in children is associated with lower median FACES scores and decreased use of opioid and nonopioid medications compared with LAI. Future studies could examine the use of longer-acting anesthetic agents with ultrasonography-guided BRSB.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT01015053.
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts4now with the Department of Anesthesia, Cohen Children's Medical Center of New York, North Shore-Long Island Jewish Health System, New Hyde Park, New York.
authors.forename: R Scott
authors.initials: RS
authors.lastname: Dingeman
authors.forename: Lindsay M
authors.initials: LM
authors.lastname: Barus
authors.forename: Hyun Kee
authors.initials: HK
authors.lastname: Chung
authors.forename: David J
authors.initials: DJ
authors.lastname: Clendenin
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Lee
authors.forename: Sarah
authors.initials: S
authors.lastname: Tracy
authors.forename: Victor M
authors.initials: VM
authors.lastname: Johnson
authors.forename: Kate V
authors.initials: KV
authors.lastname: Dennett
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.forename: Catherine
authors.initials: C
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000577:Amides / Q000008:administration & dosage; D000772:Anesthesia, Local; D000779:Anesthetics, Local / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D005260:Female; D006554:Hernia, Umbilical / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D009407:Nerve Block; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D000077212:Ropivacaine; D018084:Ultrasonography, Interventional
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine