http://pubs.jamanetwork.com/ en-us Wed, 12 Jun 2013 00:00:00 GMT Wed, 12 Jun 2013 16:43:53 GMT Silverchair editor@pubs.jamanetwork.com webmaster@pubs.jamanetwork.com http://pubs.jamanetwork.com/article.aspx?articleID=1696121 Wed, 12 Jun 2013 00:00:00 GMT Dingeman R, Barus LM, Chung H, et al. <span class="paragraphSection"><div class="boxTitle">Importance</div>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).<div class="boxTitle">Objective</div>To compare efficacy of ultrasonography-guided BRSB and local anesthetic infiltration (LAI) in providing postoperative analgesia after pediatric umbilical hernia repair.<div class="boxTitle">Design</div>Prospective, observer-blinded, randomized clinical trial.<div class="boxTitle">Setting</div>Tertiary-referral urban children's hospital.<div class="boxTitle">Participants</div>Eligible children 3 to 12 years of age undergoing elective umbilical hernia repair from November 16, 2009, through May 31, 2011.<div class="boxTitle">Interventions</div>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).<div class="boxTitle">Main Outcomes and Measures</div>Scores on the FACES Pain Rating Scale measured at 10-minute intervals and all use of analgesic medications in the PACU.<div class="boxTitle">Results</div>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).<div class="boxTitle">Conclusions and Relevance</div>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.<div class="boxTitle">Trial Registration</div>clinicaltrials.gov Identifier: NCT01015053</span> 1 7 10.1001/jamasurg.2013.1442 http://pubs.jamanetwork.com/article.aspx?articleID=1696121 http://pubs.jamanetwork.com/article.aspx?articleID=1696122 Wed, 12 Jun 2013 00:00:00 GMT Warner BW. <span class="paragraphSection">Important to the overall experience for a child undergoing elective surgery is effective pain management. In this excellent study by Dingeman et al, a randomized prospective trial compared infiltration of local anesthetic with an ultrasonography-guided bilateral rectus sheath block (BRSB) after umbilical hernia repair. The authors report that the overall pain scores were better with fewer supplemental pain medications needed in the BRSB group.</span> 1 1 10.1001/jamasurg.2013.1453 http://pubs.jamanetwork.com/article.aspx?articleID=1696122