Utilizing Preoperative Rectus Sheath Blocks to Decrease Opioid Administration During Pediatric Umbilical Hernia Repair

Introduction

Regional anesthetic blocks are an adjunct to decrease pediatric opioid utilization and improve perioperative pain control. We compared opioid use in patients who underwent umbilical hernia repair (UHR) with or without preoperative bilateral rectus sheath block (BRSB).

Methods

We conducted a single-center retrospective cohort study evaluating opioid use in patients <18 years who underwent an UHR. Two time periods were compared. From 1/1/2019-7/31/2020, BRSB was not routinely performed. From 1/1/2022-7/31/2023, BRSB was routinely performed with UHR. Patient demographics, intra- and postoperative medications, BRSB procedure and follow-up data were collected. Descriptive statistics and bivariate analysis were performed to compare the two groups.

Results

Of 256 patients, mean age was 5.1 years (SD = 2.4) and 55 % were female. Decreased amounts of intraoperative (No BRSB: 0.13 versus BRSB: 0.04, p < 0.001) and post-anesthesia (No BRSB: 0.04 versus BRSB: 0.02, p = 0.005) intravenous opioids (MME/kg) were given following BRSB (Table). Of 132 patients who received a BRSB, 121 (92 %) had telephone follow-up. Ninety-seven percent (n = 117) reported adequate postoperative pain control with the BRSB lasting for a median of 9 h (IQR 6–12).

Conclusion

Children who underwent an UHR with BRSB received decreased intraoperative and postoperative opioid amounts. Nearly all patients who received a BRSB reported adequate postoperative pain control. Preoperative regional anesthetic blocks can be used to decrease opioid use in the perioperative period with satisfactory pain control.

Level of Evidence

Level III.