Impact of Ultrasound-Guided Rectus Abdominis Sheath Block on Analgesia and Agitation During the Awakening Period in Children Undergoing Single-Incision Laparoscopic Inguinal Hernia Repair: A Randomized Clinical Trial

Abstract

Purpose: Inguinal hernia repair (IHR) is one of the most common pediatric surgeries, particularly in early childhood. Postoperative pain from IHR can cause significant psychological and physiological distress in children. This study investigates the efficacy and safety of ultrasound-guided rectus sheath block (RSB) in managing postoperative pain and emergence agitation (EA) in children undergoing single-incision laparoscopic inguinal hernia repair, aiming to improve strategies for postoperative care. Patients and Methods: This single-blind, prospectively, randomized controlled trial enrolled 90 pediatric patients who were randomly assigned to three groups, they were respectively the bilateral rectus abdominis sheath block group under ultrasound guidance (Group R), Local anesthesia infiltration group (Group L) and blank control group (Group C). Primary outcomes included the incidence of EA. Secondary outcomes comprised pain scores, opioid consumption, and adverse events, and Pediatric Anesthesia Emergence Delirium (PAED) scales at various postoperative time points. Results: EA incidence was significantly reduced in Groups R compared to Group C (RR [95% confidence interval] of 0.083 [0.007,0.019], P < 0.05). Extubation time in Group R (RSB) was significantly shorter compared to Group C (P < 0.05). During skin incision, mean arterial pressure (MAP) and heart rate (HR) were lower in Group R than in Groups L and C, with significant differences noted only between Groups R and C (P < 0.05). Postoperative pain scores were significantly reduced in Groups R and L compared to Group C (P < 0.05). Additionally, Group R demonstrated prolonged analgesia and reduced opioid consumption. Conclusion: Ultrasound-guided RSB is a safe and effective technique for postoperative analgesia in pediatric single-incision laparoscopic inguinal hernia repair. It provides superior pain relief, reduces EA incidence, and minimizes opioid use. These findings suggest that RSB may be a valuable adjunct to general anesthesia for this specific procedure.