title: Rectus sheath block for laparoscopic appendicectomy: a randomized clinical trial.
abstract: BACKGROUND
  The rectus sheath block is effective in elective paediatric operations, but has not been previously studied in acute laparoscopic surgery. We investigated its effect on pain after laparoscopic appendicectomy for acute appendicitis.
  
  
  METHODS
  Children aged 8-14 years admitted to a paediatric teaching hospital participated in a randomized clinical trial comparing a rectus sheath block using bupivacaine plus adrenaline with saline control. The primary outcomes were pain scores and opiate use, and secondary outcomes were time in the post-anaesthetic care unit, duration of hospitalization and recovery.
  
  
  RESULTS
  Children in the nerve block group reported significantly reduced global pain scores compared with controls in the first 3 h after surgery, estimated mean 2.22 versus 3.94, effect size -1.80 (P = .008). Pain scores after 3 h did not differ between the groups. The groups did not differ in opiate requirements, length of hospital stay or recovery after discharge.
  
  
  CONCLUSIONS
  In children undergoing acute laparoscopic appendicectomy, a rectus sheath block reduced early post-operative pain, and could contribute to a multimodal recovery programme.
authors.affiliation: Department of Paediatric Surgery, Starship Children's Hospital, Auckland, New Zealand.|Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
authors.forename: James K
authors.initials: JK
authors.lastname: Hamill
authors.affiliation: Department of Anaesthesia, Starship Children's Hospital, Auckland, New Zealand.
authors.forename: Andrew
authors.initials: A
authors.lastname: Liley
authors.affiliation: Faculty of Medical and Health Sciences, South Auckland Clinical School, School of Medicine, University of Auckland, Auckland, New Zealand.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Hill
mesh_terms: D000293:Adolescent; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D002045:Bupivacaine / Q000008:administration & dosage*; D002648:Child; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D002045:Bupivacaine
keywords: analgesia; appendectomy; child; laparoscopy; nerve block