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The following is a summary of “Utilizing Preoperative Rectus Sheath Blocks to Decrease Opioid Administration during Pediatric Umbilical Hernia Repair,” published in the February 2025 issue of Pediatrics by Krinock et al.

This study evaluates the impact of preoperative bilateral rectus sheath block (BRSB) on opioid utilization and pain management in pediatric patients undergoing umbilical hernia repair (UHR). Given the ongoing concerns regarding opioid overuse in children, this research aims to identify effective strategies for minimizing opioid consumption while ensuring adequate pain control.

A single-center retrospective cohort study was conducted, involving patients under 18 years who underwent UHR. The study compared two distinct periods: from January 1, 2019, to July 31, 2020, when BRSB was not routinely performed, and from January 1, 2022, to July 31, 2023, when BRSB became a standard practice. Data collected included patient demographics, intraoperative and postoperative medication use, details of the BRSB procedure, and follow-up outcomes. Descriptive statistics and bivariate analyses were employed to assess differences between the two groups.

The study included 256 patients with a mean age of 5.1 years (SD = 2.4), of whom 55% were female. Results indicated a significant reduction in opioid administration following BRSB. Specifically, intraoperative opioid use decreased from 0.13 MME/kg in the no BRSB group to 0.04 MME/kg in the BRSB group (p < 0.001). Similarly, postoperative opioid use dropped from 0.04 MME/kg to 0.02 MME/kg (p = 0.005). Among the 132 patients who received a BRSB, follow-up data were available for 121 (92%), with an impressive 97% (n = 117) reporting satisfactory postoperative pain control. The analgesic effect of the BRSB lasted for a median duration of nine hours (IQR 6-12).

In conclusion, the implementation of preoperative bilateral rectus sheath block significantly reduced both intraoperative and postoperative opioid requirements in children undergoing umbilical hernia repair. Additionally, nearly all patients reported adequate pain control post-surgery. These findings suggest that regional anesthetic techniques can effectively decrease opioid usage during the perioperative period while maintaining satisfactory pain management outcomes. Further studies are warranted to confirm these benefits and explore broader applications in pediatric surgical practices.

Source: sciencedirect.com/science/article/abs/pii/S0022346825000247