Clinical trial NCT06913205: Rectus Sheath Block and Local Wound Infiltration in Pediatric Laparoscopic Appendectomies
Official title: Comparison of Regional Block Techniques Used for Postoperative Pain Management in Laparoscopic Appendectomy in Children
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Appendectomy, Laparoscopic
Pediatric Anesthesia
Nerve Block/Methods
Regional Anesthesia
Acute Pain, Postoperative
Keywords: laparoscopic appendectomy
pediatric anesthesia
nerve blocks
regional anesthesia
acute postoperative pain
Lead sponsor: Bursa City Hospital
Sponsor class: OTHER_GOV
First posted: 2025-04-06
Enrollment: 145
Sex: ALL
Minimum age (years): 8
Maximum age (years): 18
Standard ages: CHILD
ADULT
Accepts healthy volunteers: no
Observational model: CASE_CONTROL
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Children undergoing laparoscopic appendectomy surgery in Bursa Yuksek Ihtisas Training and Research Hospital

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.

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

Primary outcomes:
measure: Analgesic consumption
timeFrame: Postoperative first 24 hours.
Secondary outcomes:
measure: Postoperative pain scores
timeFrame: Postoperative first 24 hours.
Other outcomes:
Locations:
city: Bursa
country: Turkey
facility: University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital
Study officials:
References:
citation: 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.
citation: 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.
citation: 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.