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document
Ultrasonography-guided bilateral rectus sheath block vs local anesthetic infiltration after pediatric umbilical hernia repair : a prospective randomized clinical trial . IMPORTANCE Regional 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 ) . OBJECTIVE To compare efficacy of ultrasonography-guided BRSB and local anesthetic infiltration ( LAI ) in providing postoperative analgesia after pediatric umbilical hernia repair . DESIGN Prospective , observer-blinded , randomized clinical trial . SETTING Tertiary-referral urban children 's hospital . PARTICIPANTS Eligible children 3 to 12 years of age undergoing elective umbilical hernia repair from November 16 , 2009 , through May 31 , 2011 . INTERVENTIONS Ropivacaine 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 MEASURES Scores on the FACES Pain Rating Scale measured at 10-minute intervals and all use of analgesic medications in the PACU . RESULTS Median 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 RELEVANCE In 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 REGISTRATION clinicaltrials.gov Identifier : NCT01015053 .
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Intervention_Physical
Ultrasonography-guided bilateral rectus sheath block
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Intervention_Physical
local anesthetic infiltration
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Intervention_Pharmacological
Regional anesthetic techniques
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Intervention_Pharmacological
Ropivacaine hydrochloride
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Intervention_Surgical
surgery
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Participant_Condition
Tertiary-referral urban children 's hospital .