Ultrasound-guided rectus sheath block or wound infiltration in children: a randomized blinded study of analgesia and bupivacaine absorption.

Abstract

BACKGROUND:

Rectus sheath block can provide analgesia following umbilical hernia repair. However, conflicting reports on its analgesic effectiveness exist. No study has investigated plasma local anesthetic concentration following ultrasound-guided rectus sheath block (USGRSB) in children.

OBJECTIVES:

Compare the effectiveness and bupivacaine absorption following USGRSB or wound infiltration (WI) for umbilical hernia repair in children.

METHODS:

A randomized blinded study comparing WI with USGRSB in 40 children undergoing umbilical hernia repair was performed. Group WI (n = 20) received wound infiltration 1 mg·kg(-1) 0.25% bupivacaine. Group RS (n = 20) received USGRSB 0.5 mg·kg(-1) 0.25% bupivacaine per side in the posterior rectus sheath compartment. Pain scores and rescue analgesia were recorded. Blood samples were drawn at 0, 10, 20, 30, 45, and 60 min.

RESULTS:

Patients in the WI group had a twofold increased risk of requiring morphine (hazard ratio 2.06, 95% CI 1.01, 4.20, P = 0.05). When required, median time to first morphine dose was longer in the USGRSB group (65.5 min vs. 47.5 min, P = 0.049). Peak plasma bupivacaine concentration was higher following USGRSB than WI (median: 631.9 ng·ml(-1) IQR: 553.9-784.1 vs. 389.7 ng·ml(-1) IQR: 250.5-502.7, P = 0.002). Tmax was longer in the USGRSB group (median 45 min IQR: 30-60 vs. 20 min IQR: 20-45, P = 0.006).

CONCLUSIONS:

USGRSB provides more effective analgesia than WI for umbilical hernia repair. USGRSB with 1 mg·kg(-1) 0.25% bupivacaine is associated with safe plasma bupivacaine concentration that peaks higher and later than WI. Caution against using larger volumes of higher concentration local anesthetic for USGRSB is advised.

• Authors: Sean H Flack, Lizabeth D Martin, Benjamin J Walker, Adrian T Bosenberg, Laurilyn D Helmers, Adam B Goldin, Charles M Haberkern
• Journal: Paediatric anaesthesia (Paediatr Anaesth) Vol. 24 Issue 9 Pg. 968-73 (Sep 2014) ISSN: 1460-9592 [Electronic] France
• PMID: 24853314 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural)
• Copyright: © 2014 John Wiley & Sons Ltd.

Chemical References

• Anesthetics, Local
• Bupivacaine

Topics

• Adolescent
• Analgesia (methods)
• Anesthetics, Local (administration & dosage, pharmacokinetics, therapeutic use)
• Bupivacaine (administration & dosage, pharmacokinetics, therapeutic use)
• Child
• Child, Preschool
• Female
• Hernia, Umbilical (surgery)
• Humans
• Infant
• Male
• Nerve Block (methods)
• Rectus Abdominis (diagnostic imaging, drug effects)
• Single-Blind Method
• Treatment Outcome
• Ultrasonography, Interventional