• R Scott Dingeman, Lindsay M Barus, Hyun Kee Chung, David J Clendenin, Christopher S Lee, Sarah Tracy, Victor M Johnson, Kate V Dennett, David Zurakowski, and Catherine Chen.
• Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts4now with the Department of Anesthesia, Cohen Children's Medical Center of New York, North Shore-Long Island Jewish Health System, New Hyde Park, New York.
• JAMA Surg. 2013 Aug 1;148(8):707-13.

ImportanceRegional anesthetic techniques can be used to alleviate postoperative pain in children undergoing pediatric surgical procedures. Use of ultrasonographic guidance for bilateral rectus sheath block (BRSB) has been shown to improve immediate pain scores and reduce use of postoperative analgesia in the postanesthesia care unit (PACU).ObjectiveTo compare efficacy of ultrasonography-guided BRSB and local anesthetic infiltration (LAI) in providing postoperative analgesia after pediatric umbilical hernia repair.DesignProspective, observer-blinded, randomized clinical trial.SettingTertiary-referral urban children's hospital.ParticipantsEligible children 3 to 12 years of age undergoing elective umbilical hernia repair from November 16, 2009, through May 31, 2011.InterventionsRopivacaine hydrochloride administered at the conclusion of surgery as LAI by the surgeon (n = 25) or as ultrasonography-guided BRSB by the anesthesiologist (n = 27).Main Outcomes And MeasuresScores on the FACES Pain Rating Scale measured at 10-minute intervals and all use of analgesic medications in the PACU.ResultsMedian FACES scores in the PACU were lower in the BRSB group compared with the LAI group at 10 minutes (0 vs 1; P = .04), 30 minutes (0 vs 1; P = .01), and 40 minutes or later (0 vs 1; P = .03). Fewer doses of opioid and nonopioid medications were given to the BRSB group compared with the LAI group (5 vs 11 doses for opioids; 5 vs 10 for nonopioids).Conclusions And RelevanceIn the PACU, ultrasonography-guided BRSB after umbilical hernia repair in children is associated with lower median FACES scores and decreased use of opioid and nonopioid medications compared with LAI. Future studies could examine the use of longer-acting anesthetic agents with ultrasonography-guided BRSB.Trial Registrationclinicaltrials.gov Identifier: NCT01015053.

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