Umbilical hernia repair is a common painful outpatient procedure performed in children.
Often analgesia for this procedure is provided by using local infiltration of the surgical
site by the surgeons and perioperative opioids and NSAIDS both IV and orally. The use of
opioids can cause adverse side effects which include, but are not limited to nausea,
vomiting, itching, and respiratory depression, etc. The rectus sheath block can be performed
in these patients to decrease their post operative pain.
Umbilical hernia repair, a common Day Surgery procedure in children, is associated with
considerable postoperative discomfort. The patient has to meet certain discharge criteria
such as tolerating liquids, adequate level of analgesia, etc., prior to being discharged
from the day surgery unit.
Currently, both rectus sheath block and local infiltration of the surgical site are used for
providing post-operative analgesia for umbilical hernia repair surgery. The local
infiltration can only be done at the end of the surgical procedure as it could alter the
planes of the surgical field if performed preoperatively. We believe that the analgesia
provided prior to the surgical incision will decrease the amount of intraoperative and
postoperative opioids used and the subsequent side effects of these medications (5,6). The
rectus sheath block, a regional anesthetic technique, offers possible improved pain
management following umbilical hernia repair in a recent observational study (1-3,7). We
will perform a double-blinded, randomized study to compare the efficacy of rectus sheath
block and surgical infiltration in providing postoperative analgesia.
1. Male or female subjects ages > 5 to < 18 years.
2. ASA physical status 1 or 2.
3. Patients who undergo an umbilical hernia repair at CHOP.
1. Parents/patients refusal to the placement of a rectus sheath nerve block.
2. Subjects with allergy to bupivacaine.
3. Patients who are developmentally delayed which precludes their participation in pain
4. Parents who do not comprehend English sufficiently well to read the consent and ask