ASA Abstract Reviews

A Comparison of Caudal Analgesia Versus Ultrasound-guided Rectus Sheath Blocks for Umbilical Herniorrhaphy in the Pediatric Population

Lance M. Relland, MD, PhD; Joseph Tobias, MD; David Martin, MD; Giorgio Veneziano, MD; Ralph Beltran, MD; Christopher McKee, DO; Tarun Bhalla, MBA, MD
Nationwide Children's Hospital, Columbus, Ohio, United States
(Summarized and submitted by Lance M. Relland, MD, PhD)

In a prospective, double-blinded, randomized study, Relland et al. compared three modalities of using local anesthetics for umbilical herniorrhaphy in children. This study is unique in that the timing of administration was pre-incisional in each case, which included one of the following methods: caudal block, bilateral rectus sheath blocks or surgical site infiltration. Each group contained 12 to 13 patients, all were similar demographically, and each underwent a standardized general anesthetic in addition to the respective regional technique. Pain and recovery scores assessed postoperatively did not yield any significant difference between the groups. Overall, fewer than half of the patients required intravenous analgesia in the recovery room, all had similar intraoperative opioid requirements, and length of stay was similar in each case.

This study employed a variety of regional anesthetic techniques that each may offer similar levels of analgesia, which is significant in providing alternatives to the neuraxial approach and helping to minimize the need for opioids or general anesthesia. These findings are important especially in the context of growing concerns with regards to the opioid epidemic and the potential for neurotoxicity with general anesthetics. Diversification of pediatric anesthesiologists’ repertoire may change the daily practice and facilitate optimization of patient care and satisfaction.