Laparoscopic appendectomies are the most common emergency surgeries performed in children. Despite being considered minimally invasive surgeries, they can result in substantial postoperative pain and 2 of 3 patients require postoperative opioids. Increased postoperative pain can delay recovery, increase hospital admission time, lead to chronic pain, and cause patient distress. This study aims to reduce postoperative pain in this population by comparing the recovery outcomes associated with the administration of (1) an RSB with coadministration of IV dexamethasone as an LA adjunct (RSB+dex group) prior to the incision with (2) LA infiltration alone by the surgeon (LA group).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
32
Bilateral rectus sheath blocks using an in-plane ultrasound-guided technique with 0.25% bupivacaine with epinephrine 1:200 000 at 0.8 mL/kg (half of total volume per side) up to a maximum of 20 mL prior to the incision.
0.25% bupivacaine with epinephrine 1:200 000. Total dose of 0.8 mL/kg (maximum 20 mL) at the umbilical port site.
Intravenous Dexamethasone delivered concurrent to the RSB. Total dose of 150 mcg/kg up to a maximum of 8 mg.
The remaining volume of local anesthetic (0.2 mL/kg) can be infiltrated at each of the incision sites at the discretion of the surgeon up to a maximum of 10 mL.
British Columbia Children's Hospital
Vancouver, British Columbia, Canada
Total opioid administration
Continuous variable measured by collecting and totaling all opioid (excluding remifentanil) administrations from intraoperative, anesthetic care unit (ACU), and ward records and converting to morphine milligram per kilogram equivalents.
Time frame: From the start of surgery until up to 16 hours post-operatively.
Mean postoperative pain score at 12 hours
Discrete variable measured via age-appropriate visual analog scale (Faces Pain Scale-Revised) for participants who are younger than 12 years old. The Faces Pain Scale is on a scale of 0 to 10, where 0 is no pain and 10 is the worst pain imaginable.
Time frame: 12 hours postoperatively
Pain scores at 0 hours, 4 hours, 8 hours, and 16 hours postoperatively
Discrete variable measured via age-appropriate visual analog scale (FACES Pain Scale-Revised) for participants who are younger than 12 years old. The Faces Pain Scale is on a scale of 0 to 10, where 0 is no pain and 10 is the worst pain imaginable.
Time frame: 0 hours, 4 hours, 8 hours, and 16 hours postoperatively.
Time spent performing rectus sheath block
Time performing the rectus sheath block in minutes as recorded by the anesthesiologist.
Time frame: Intraoperatively.
Duration of anesthesia care unit (ACU) stay
Time between ACU admission and discharge.
Time frame: Perioperatively.
Duration of post-procedural hospitalization
Duration from entering the operating room to hospital discharge in minutes.
Time frame: Baseline (upon entering the operating room) to discharge from hospital, an average of 16 hours.
Parental perspective on patient postoperative pain
Parental assessment of patient postoperative pain using a numeric rating scale. The scale is from 0 to 10, where 0 is no pain and 10 is the worst pain imaginable.
Time frame: 24 to 72 hours postoperatively
Non-prescription postoperative drugs
Which non-prescription drugs are administered post-operatively from the parent to the patient.
Time frame: 24 to 72 hours postoperatively
Parental satisfaction with recovery
Discrete 5-point scale (very unsatisfied, unsatisfied, neutral, satisfied, very satisfied) measuring parental satisfaction with patient recovery. Very unsatisfied is the worse outcome, very satisfied is the best outcome.
Time frame: 24 to 72 hours postoperatively.
Mean Postoperative Pain Score at 12 Hours
Discrete variable measured via age-appropriate scale (Numeric Rating Scale) for participants who are 12 years old or older. The numeric rating scale is from 0 to 10, where 0 is no pain and 10 is the worst pain imaginable.
Time frame: 12 hours postoperatively
Pain scores at 0 hours, 4 hours, 8 hours, and 16 hours postoperatively
Discrete variable measured via age-appropriate scale (Numeric Rating Scale) for participants who are 12 years old or older. The numeric rating scale is from 0 to 10, where 0 is no pain and 10 is the worst pain imaginable.
Time frame: 0 hours, 4 hours, 8 hours, and 16 hours postoperatively.
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