title: Comparison of the analgesic efficacy of ultrasound-guided rectus sheath block and local anesthetic infiltration for laparoscopic percutaneous extraperitoneal closure in children.
abstract: BACKGROUND
  Ultrasound-guided rectus sheath block and local anesthetic infiltration are the standard options to improve postoperative pain for children undergoing surgery with a midline incision. However, there is no study comparing the effect of ultrasound-guided rectus sheath block with local anesthetic infiltration for children undergoing laparoscopic surgery.
  
  
  OBJECTIVE
  The aim of this trial was to compare the onset of ultrasound-guided rectus sheath block with that of local anesthetic infiltration for laparoscopic percutaneous extraperitoneal closure in children.
  
  
  METHODS
  We performed an observer-blinded, randomized, prospective trial. Enrolled patients were assigned to either an ultrasound-guided rectus sheath block group or a local anesthetic infiltration group. The ultrasound-guided rectus sheath block group (n = 17) received ultrasound-guided rectus sheath block with 0.2 ml·kg-1of 0.375% ropivacaine per side in the posterior rectus sheath compartment. The local anesthetic infiltration group (n = 17) received local anesthetic infiltration with 0.2 ml·kg-1of 0.75% ropivacaine. The Face, Legs, Activity, Cry, and Consolability (FLACC) pain scores were recorded at 0, 30, 60 min after arrival at the postanesthesia care unit.
  
  
  RESULTS
  Of the 37 patients enrolled in this study, 34 completed the study protocol. A significant difference in the pain scale between the ultrasound-guided rectus sheath block group and local anesthetic infiltration group was found at 0 min (median: 0, interquartile range [IQR]: 0-1.5, vs median: 1, IQR 0-5, confidence interval of median [95% CI]: 0-3, P = 0.048), but no significant difference was found at 30 min (median: 1, IQR: 0-4 vs median: 6, IQR: 0-7, 95% CI: 0-5, P = 0.061), or 60 min (median: 0, IQR: 0-2 vs median: 1, IQR: 0-3, 95% CI: -1 to 1, P = 0.310). No significant difference was found in anesthesia time between the ultrasound-guided rectus sheath block and local anesthetic infiltration groups. No procedure-related complications were observed in either group.
  
  
  CONCLUSIONS
  Ultrasound-guided rectus sheath block is a quicker way to control postoperative pain for pediatric patients undergoing laparoscopic extraperitoneal closure than local anesthetic infiltration, and thus may provide a clinical benefit.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Uchinami
authors.affiliation: Department of Anesthesiology, Caress Alliance Tenshi Hospital, Sapporo, Japan.
authors.forename: Fumika
authors.initials: F
authors.lastname: Sakuraya
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Tanaka
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Hoshino
authors.affiliation: Department of Anesthesiology, Caress Alliance Tenshi Hospital, Sapporo, Japan.
authors.forename: Eri
authors.initials: E
authors.lastname: Mikami
authors.affiliation: Department of Anesthesiology, Caress Alliance Tenshi Hospital, Sapporo, Japan.
authors.forename: Taro
authors.initials: T
authors.lastname: Ishikawa
authors.affiliation: Department of Anesthesiology, Caress Alliance Tenshi Hospital, Sapporo, Japan.
authors.forename: Hitomi
authors.initials: H
authors.lastname: Fujii
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
authors.forename: Takehiko
authors.initials: T
authors.lastname: Ishikawa
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Morimoto
mesh_terms: D000577:Amides; D000698:Analgesia / Q000009:adverse effects / Q000379:methods*; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D010147:Pain Measurement / Q000187:drug effects; D011446:Prospective Studies; D000077212:Ropivacaine; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine
keywords: local anesthetics; outpatient; pain