P. S. Kamat1, D. M. Ferguson1, S. A. Arshad1, C. M. Anding1, A. P. Bain1, E. I. Garcia1, N. B. Hebballi1, S. D. Cameron1, K. Tsao1, M. T. Austin1 1McGovern Medical School at UTHealth,Department Of Pediatric Surgery,Houston, TX, USA
Introduction:
Regional blocks have been shown to effectively decrease pain after abdominal surgery, and some evidence suggests they also reduce postoperative opioid consumption. Despite their valuable analgesic effects, regional blocks are not routinely used in many pediatric abdominal procedures. We aimed to identify factors associated with regional block use in pediatric appendicitis.
Methods:
We performed a retrospective review of all pediatric (<18 years) patients who underwent laparoscopic appendectomy for acute appendicitis between January 1, 2018 and April 30, 2019 at a single institution. Patients who underwent open or interval appendectomies were excluded. The primary outcome was perioperative receipt of a regional block. Factors thought to influence regional block utilization were chosen a priori based on prior literature and clinical knowledge and included patient age, gender, weight, race/ethnicity, insurance status, diagnosis (simple versus complicated appendicitis), time of surgery, weekday versus weekend surgery, and case duration. Univariate analysis and multiple variable logistic regression were performed.
Results:
Of 546 patients who met inclusion criteria, 103 received regional blocks (19%). Of those, 73% received a quadratus lumborum block and 24% received a transversus abdominis plane block (block type not specified in 3%). On univariate analysis, block and no-block patients were similar by age, gender, weight, race/ethnicity, insurance status, and surgical diagnosis (p>0.3 for all comparisons). Block patients underwent weekday surgery more frequently than no-block patients (87% vs. 68%, p<0.001). The majority (76%) of blocks were performed between 7am and 1pm (n=79). After adjusting for age, gender, weight, race/ethnicity, insurance status, diagnosis, case duration, weekday versus weekend, and time of day, weekday surgery was the only factor independently associated with receiving a regional block (adjusted OR 3.6, 95% CI 1.9-6.7, Table).
Conclusion:
Weekday surgery was independently associated with receiving a regional block in pediatric appendicitis patients. Availability of an anesthesiologist who is trained to perform blocks and/or time constraints may currently be the primary determinant of regional block utilization. Training more anesthesiologists to perform blocks may increase use and improve pain control in this population.
