Rectus Sheath Block and Local Wound Infiltration in Pediatric Laparoscopic Appendectomies

NCT ID: NCT06913205

Last Updated: 2025-04-06

Basic Information

• Recruitment Status: COMPLETED
• Total Enrollment: 145 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2021-08-25
• Study Completion Date: 2025-03-25

Brief Summary

Laparoscopic appendectomy surgeries are among the most commonly performed procedures in childhood. However, they are associated with moderate to severe postoperative pain. Regional nerve block techniques are recommended for postoperative pain management. This research compared the two most frequently used methods: rectus sheath block and local wound infiltration.

Detailed Description

Acute appendectomy surgeries are one of the most frequently performed surgeries in childhood. Minimally invasive (laparoscopic) surgical methods are recommended, especially in abdominal surgeries, due to rapid wound healing, rapid recovery, less bleeding, and shorter hospital stays compared to open surgery. In addition to all these advantages of laparoscopic surgeries, postoperative somatic pain is expected to be less compared to open surgeries due to the small incisions in the abdominal wall. However, when the pain severity of children who underwent laparoscopic appendectomy was evaluated using the pain scoring scale, it was seen that the median pain scores were ≥7 in 5% of the children (severe pain) and ≥4 in 25% (moderate pain). Clinical practice guidelines also recommend the use of regional anesthesia and analgesia methods as part of multimodal analgesia in the prevention of intraoperative and postoperative pain. We also routinely use regional anesthesia and analgesia methods successfully and effectively in our daily practices in our clinic.

Rectus sheath blocks, which are known to be effective in midline incisions, and local anesthetic infiltrations of the wound site, which do not require special technical knowledge about regional anesthesia, are routinely applied in our clinic in every case. Although both methods provide clinical benefits, it is unknown which one is superior to the other.

Conditions

Appendectomy, Laparoscopic; Pediatric Anesthesia; Nerve Block/Methods; Regional Anesthesia; Acute Pain, Postoperative

Study Design

• Observational Model Type: CASE_CONTROL
• Study Time Perspective: PROSPECTIVE

Study Groups

Rectus Sheath Block

Children undergoing laparoscopic appendectomy with rectus sheath blocks

No interventions assigned to this group

Local infiltration

Children undergoing laparoscopic appendectomy with local infiltration

No interventions assigned to this group

Eligibility Criteria

Inclusion Criteria

• Older than 8 years
• Younger than 18 years
• Minimal invasive appendectomy (3 port)
• Consent to participate

Exclusion Criteria

• Younger than 8 years
• Older than 18 years
• Convert to open abdominal surgery
• Do not consent to participate

• Minimum Eligible Age: 8 Years
• Maximum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Bursa City Hospital

OTHER_GOV

Sponsor Role: lead

Responsible Party

Hande Gurbuz

Assoc. Prof. MD. PhD

Responsibility Role: PRINCIPAL_INVESTIGATOR

Locations

University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital

Bursa, Bursa, Turkey (Türkiye)

Countries

Turkey (Türkiye)

References

Hamill JK, Liley A, Hill AG. Rectus sheath block for laparoscopic appendicectomy: a randomized clinical trial. ANZ J Surg. 2015 Dec;85(12):951-6. doi: 10.1111/ans.12950. Epub 2015 Jan 12.

Reference Type: BACKGROUND

PMID: 25581711 (View on PubMed)

Liu Y, Seipel C, Lopez ME, Nuchtern JG, Brandt ML, Fallon SC, Manyang PA, Tjia IM, Baijal RG, Watcha MF. A retrospective study of multimodal analgesic treatment after laparoscopic appendectomy in children. Paediatr Anaesth. 2013 Dec;23(12):1187-92. doi: 10.1111/pan.12271. Epub 2013 Sep 25.

Reference Type: BACKGROUND

PMID: 24112856 (View on PubMed)

Tomecka MJ, Bortsov AV, Miller NR, Solano N, Narron J, McNaull PP, Ricketts KJ, Lupa CM, McLean SA. Substantial postoperative pain is common among children undergoing laparoscopic appendectomy. Paediatr Anaesth. 2012 Feb;22(2):130-5. doi: 10.1111/j.1460-9592.2011.03711.x. Epub 2011 Sep 29.

Reference Type: BACKGROUND

PMID: 21958060 (View on PubMed)

Gurbuz H, Karasu D, Dogan AK, Kilicarslan N. Rectus sheath blocks for pediatric laparoscopic appendicectomy. BMC Anesthesiol. 2025 Sep 29;25(1):462. doi: 10.1186/s12871-025-03364-9.

Reference Type: DERIVED

PMID: 41023777 (View on PubMed)

Other Identifiers

2011-KAEK-25 2021/08-20

Identifier Type: -

Identifier Source: org_study_id