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Ultrasound‐guided rectus sheath block or wound infiltration in children: a randomized blinded study of analgesia and bupivacaine absorption
Author(s) -
Flack Sean H.,
Martin Lizabeth D.,
Walker Benjamin J.,
Bosenberg Adrian T.,
Helmers Laurilyn D.,
Goldin Adam B.,
Haberkern Charles M.
Publication year - 2014
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/pan.12438
Subject(s) - medicine , bupivacaine , anesthesia , rectus sheath , umbilical hernia , analgesic , local anesthetic , randomized controlled trial , surgery , hernia , abdominal wall
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.