Percutaneous ultrasound-guided vs. intraoperative rectus sheath block for pediatric umbilical hernia repair: A randomized clinical trial

Cristen N. Litz, Sandra M. Farach, Allison M. Fernandez, Richard Elliott, Jenny Dolan, Nikhil Patel, Lillian Zamora, Paul M. Colombani, Nebbie Walford, Ernest K. Amankwah, Christopher W. Snyder, Paul D. Danielson, Nicole M. Chandler

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Background: Regional anesthesia is commonly used in children. Our hypothesis was that percutaneous ultrasound-guided (PERC) rectus sheath blocks would result in lower postoperative pain scores compared to intraoperative (IO) rectus sheath blocks following umbilical hernia repair. Methods: A single-institution randomized blinded trial was conducted in pediatric patients undergoing elective umbilical hernia repair. The primary outcome was mean postoperative Wong-Baker pain score. Secondary outcomes included narcotic requirements and length of postoperative stay. Results: Fifty-eight patients were included: 28 PERC and 30 IO. Operating room time was significantly longer in the PERC group (41 vs. 35. min, p. <. 0.01). Mean postoperative pain scores (PERC-2.6 vs. IO-3.3, p = 0.11), morphine equivalents intraoperatively (PERC-0 vs. IO-0.04. mg/kg, p = 0.29) and postoperatively (PERC-0.04 vs. IO-0.09. mg/kg, p = 0.17), time to first postoperative narcotic dose (PERC-30 vs. IO-22. min, p = 0.33, log-rank test), and postoperative length of stay (PERC-76 vs. IO-80. min, p = 0.44) were similar. Conclusion: Following umbilical hernia repair in children, percutaneous ultrasound-guided and intraoperative rectus sheath blocks resulted in similar mean postoperative pain scores. There were no differences in secondary outcomes such as time to first narcotic, narcotic requirements, and length of stay. The additional resources required to complete a percutaneous ultrasound-guided rectus sheath block may not be warranted. Type of study: Randomized controlled trial. Level of evidence: Level I.

Original languageEnglish (US)
JournalJournal of Pediatric Surgery
StateAccepted/In press - Feb 24 2017


  • Pediatric
  • Rectus sheath block
  • Regional anesthesia
  • Umbilical hernia

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery


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