title: Percutaneous ultrasound-guided vs. intraoperative rectus sheath block for pediatric umbilical hernia repair: A randomized clinical trial.
abstract: BACKGROUND
  Regional anesthesia is commonly used in children. Our hypothesis was that percutaneous ultrasound-guided (PERC) rectus sheath blocks would result in lower postoperative pain scores compared to intraoperative (IO) rectus sheath blocks following umbilical hernia repair.
  
  
  METHODS
  A single-institution randomized blinded trial was conducted in pediatric patients undergoing elective umbilical hernia repair. The primary outcome was mean postoperative Wong-Baker pain score. Secondary outcomes included narcotic requirements and length of postoperative stay.
  
  
  RESULTS
  Fifty-eight patients were included: 28 PERC and 30 IO. Operating room time was significantly longer in the PERC group (41 vs. 35min, p<0.01). Mean postoperative pain scores (PERC-2.6 vs. IO-3.3, p=0.11), morphine equivalents intraoperatively (PERC-0 vs. IO-0.04mg/kg, p=0.29) and postoperatively (PERC-0.04 vs. IO-0.09mg/kg, p=0.17), time to first postoperative narcotic dose (PERC-30 vs. IO-22min, p=0.33, log-rank test), and postoperative length of stay (PERC-76 vs. IO-80min, p=0.44) were similar.
  
  
  CONCLUSIONS
  Following umbilical hernia repair in children, percutaneous ultrasound-guided and intraoperative rectus sheath blocks resulted in similar mean postoperative pain scores. There were no differences in secondary outcomes such as time to first narcotic, narcotic requirements, and length of stay. The additional resources required to complete a percutaneous ultrasound-guided rectus sheath block may not be warranted.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Level I.
authors.affiliation: Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL.
authors.forename: Cristen N
authors.initials: CN
authors.lastname: Litz
authors.affiliation: Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL.
authors.forename: Sandra M
authors.initials: SM
authors.lastname: Farach
authors.affiliation: Division of Pediatric Anesthesia, Johns Hopkins All Children's Hospital, St. Petersburg, FL.
authors.forename: Allison M
authors.initials: AM
authors.lastname: Fernandez
authors.affiliation: Division of Pediatric Anesthesia, Johns Hopkins All Children's Hospital, St. Petersburg, FL.
authors.forename: Richard
authors.initials: R
authors.lastname: Elliott
authors.affiliation: Division of Pediatric Anesthesia, Johns Hopkins All Children's Hospital, St. Petersburg, FL.
authors.forename: Jenny
authors.initials: J
authors.lastname: Dolan
authors.affiliation: Division of Pediatric Anesthesia, Johns Hopkins All Children's Hospital, St. Petersburg, FL.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Patel
authors.affiliation: Division of Pediatric Anesthesia, Johns Hopkins All Children's Hospital, St. Petersburg, FL.
authors.forename: Lillian
authors.initials: L
authors.lastname: Zamora
authors.affiliation: Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Colombani
authors.affiliation: Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL.
authors.forename: Nebbie E
authors.initials: NE
authors.lastname: Walford
authors.affiliation: Clinical and Translational Research Organization, Johns Hopkins All Children's Hospital, St. Petersburg, FL.
authors.forename: Ernest K
authors.initials: EK
authors.lastname: Amankwah
authors.affiliation: Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Snyder
authors.affiliation: Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Danielson
authors.affiliation: Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL. Electronic address: Nicole.Chandler@jhmi.edu.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Chandler
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D006554:Hernia, Umbilical / Q000601:surgery*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000517:prevention & control*; D011446:Prospective Studies; D017568:Rectus Abdominis / Q000294:innervation; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
keywords: Pediatric; Rectus sheath block; Regional anesthesia; Umbilical hernia