{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T19:58:32Z","timestamp":1792180712738,"version":"4.4.0"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Despite being a minimally invasive procedure, laparoscopic appendectomy (LA) frequently induces substantial postoperative pain in children. While erector spinae plane block (ESPB) has demonstrated efficacy for postoperative analgesia in pediatric open abdominal surgery, its analgesic benefits and safety profile in laparoscopic procedures remain unestablished.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To evaluate the opioid-sparing effects, analgesic efficacy, and safety of ESPB in children undergoing LA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A single-center, double-blind, randomized, superiority trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Children aged 6\u201312 years with American Society of Anesthesiologists (ASA) physical status I\u2013II scheduled for LA at Anhui Provincial Children's Hospital were enrolled. Participants were randomly allocated 1:1 using a computer-generated sequence to receive either bilateral ultrasound-guided ESPB at T8 (0.25% ropivacaine, 0.5\u2005mL\/kg per side) after tracheal intubation (ESPB group) or no block (Control group). Both groups received standardized multimodal analgesia comprising hydromorphone-based patient-controlled intravenous analgesia (PCIA) and scheduled acetaminophen. The primary outcome was 0\u201324\u2005h cumulative hydromorphone consumption; secondary outcomes included pain scores, PCIA parameters, rescue analgesia requirements, recovery milestones, parental satisfaction, and adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 80 children randomized (40 per group), 75 completed follow-up and were analyzed (ESPB,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200937; control,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200938). The ESPB group exhibited significantly lower 24\u2005h hydromorphone consumption (32.8\u2009\u00b1\u200910.1 vs. 72.9\u2009\u00b1\u200914.5\u2005\u03bcg\/kg; mean difference: \u221240.1\u2005\u03bcg\/kg;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001), representing a 55% reduction compared with the Control group. Secondary outcomes favoring ESPB included lower pain scores during the early postoperative period (PACU to 6\u2005h;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05), prolonged time to first PCIA demand (201.0 vs. 58.5\u2005min;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001), fewer total PCIA presses (10 vs. 17;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001) and effective presses (9 vs. 17;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001) within 0\u201324\u2005h, reduced rescue analgesia requirements (2.7% vs. 21.1%;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.028), and higher parental satisfaction scores (8 vs. 7 points;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.001). No serious block-related complications occurred.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In children undergoing LA, a single-injection bilateral ultrasound-guided ESPB at T8 provides significant opioid-sparing effects and alleviates acute postoperative pain during the first 24\u2005h without increasing adverse event rates, supporting its incorporation as a component of multimodal analgesia for postoperative pain management in this population.<\/jats:p>\n                    <jats:p>\n                      <jats:bold>Clinical Trial Registration<\/jats:bold>\n                      :\n                      <jats:ext-link>https:\/\/www.chictr.org.cn<\/jats:ext-link>\n                      , identifier ChiCTR2500108148, Date of Registration: August 26, 2025.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1803495","type":"journal-article","created":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T05:36:25Z","timestamp":1777613785000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Erector spinae plane block for opioid sparing in children undergoing laparoscopic appendectomy: a randomized controlled trial"],"prefix":"10.3389","volume":"14","author":[{"given":"Ming-wen","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Anhui Provincial Children's Hospital","place":["Hefei, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-zhu","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Anhui Provincial Children's Hospital","place":["Hefei, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling-li","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Anhui Provincial Children's Hospital","place":["Hefei, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Anhui Provincial Children's Hospital","place":["Hefei, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ran","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Pediatric General Surgery, Anhui Provincial Children's Hospital","place":["Hefei, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying-ying","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Anhui Provincial Children's Hospital","place":["Hefei, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"870","DOI":"10.3390\/healthcare11060870","article-title":"Postoperative pain management in children undergoing laparoscopic appendectomy: a scoping review","volume":"11","author":"Alsharari","year":"2023","journal-title":"Healthcare (Basel)"},{"key":"B2","doi-asserted-by":"publisher","first-page":"CD001546","DOI":"10.1002\/14651858.CD001546.pub4","article-title":"Laparoscopic versus open surgery for suspected appendicitis","volume":"11","author":"Jaschinski","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"B3","doi-asserted-by":"publisher","first-page":"35","DOI":"10.4103\/0972-9941.30686","article-title":"Kurt Semm: a laparoscopic crusader","volume":"3","author":"Bhattacharya","year":"2007","journal-title":"J Minim Access Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1097\/EJA.0000000000001953","article-title":"PROSPECT working group of the European society of regional anaesthesia and pain therapy (ESRA). perioperative pain management for appendicectomy: a systematic review and procedure-specific postoperative pain management recommendations","volume":"41","author":"Freys","year":"2024","journal-title":"Eur J Anaesthesiol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1111\/j.1460-9592.2011.03711.x","article-title":"Substantial postoperative pain is common among children undergoing laparoscopic appendectomy","volume":"22","author":"Tomecka","year":"2012","journal-title":"Paediatr Anaesth"},{"key":"B6","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1097\/SLA.0000000000001882","article-title":"Intraperitoneal local anesthetic for laparoscopic appendectomy in children: a randomized controlled trial","volume":"266","author":"Hamill","year":"2017","journal-title":"Ann Surg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"882","DOI":"10.1093\/bja\/aer069","article-title":"Ultrasound-guided transversus abdominis plane blocks for laparoscopic appendicectomy in children: a prospective randomized trial","volume":"106","author":"Sandeman","year":"2011","journal-title":"Br J Anaesth"},{"key":"B8","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1016\/j.ijsu.2010.09.012","article-title":"Local anaesthetic wound infiltration following paediatric appendicectomy: a randomised controlled trial: time to stop using local anaesthetic wound infiltration following paediatric appendicectomy?","volume":"9","author":"Edwards","year":"2011","journal-title":"Int J Surg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"621","DOI":"10.1097\/AAP.0000000000000451","article-title":"The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain","volume":"41","author":"Forero","year":"2016","journal-title":"Reg Anesth Pain Med"},{"key":"B10","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1097\/AAP.0000000000000581","article-title":"The erector spinae plane block provides visceral abdominal analgesia in bariatric surgery: a report of 3 cases","volume":"42","author":"Chin","year":"2017","journal-title":"Reg Anesth Pain Med"},{"key":"B11","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1016\/j.jclinane.2019.03.006","article-title":"Erector spinae plane block vs quadratus lumborum block for pediatric lower abdominal surgery: a double blinded, prospective, and randomized trial","volume":"57","author":"Aksu","year":"2019","journal-title":"J Clin Anesth"},{"key":"B12","doi-asserted-by":"publisher","first-page":"686","DOI":"10.4103\/joacp.joacp_316_23","article-title":"Comparison of single-dose erector spinae plane block versus paravertebral block for pyeloplasty surgery in children - A prospective, randomized study","volume":"40","author":"Kundal","year":"2024","journal-title":"J Anaesthesiol Clin Pharmacol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"762","DOI":"10.4103\/ija.IJA_630_20","article-title":"The analgesic effect of bilateral ultrasound-guided erector spinae plane block in paediatric lower abdominal surgeries: a randomised, prospective trial","volume":"64","author":"Singh","year":"2020","journal-title":"Indian J Anaesth"},{"key":"B14","doi-asserted-by":"publisher","first-page":"660","DOI":"10.2471\/blt.07.043497","article-title":"Development of a WHO growth reference for school-aged children and adolescents","volume":"85","author":"de Onis","year":"2007","journal-title":"Bull World Health Organ"},{"key":"B15","doi-asserted-by":"publisher","first-page":"2132","DOI":"10.1097\/j.pain.0000000000000305","article-title":"Systematic review of the face, legs, activity, cry and consolability scale for assessing pain in infants and children: is it reliable, valid, and feasible for use?","volume":"156","author":"Crellin","year":"2015","journal-title":"Pain"},{"key":"B16","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1016\/j.annemergmed.2017.09.009","article-title":"Validity and reliability of the verbal numerical rating scale for children aged 4\u201317 years with acute pain","volume":"71","author":"Tsze","year":"2018","journal-title":"Ann Emerg Med"},{"key":"B17","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1186\/s13017-020-00306-3","article-title":"Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines","volume":"15","author":"Di Saverio","year":"2020","journal-title":"World J Emerg Surg"},{"key":"B18","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/0952-8180(94)00001-k","article-title":"The post-anesthesia recovery score revisited","volume":"7","author":"Aldrete","year":"1995","journal-title":"J Clin Anesth"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1224113","DOI":"10.3389\/fped.2023.1224113","article-title":"Single-incision laparoscopic appendectomy versus traditional three-hole laparoscopic appendectomy for acute appendicitis in children by senior pediatric surgeons: a multicenter study from China","volume":"11","author":"Liu","year":"2023","journal-title":"Front Pediatr"},{"key":"B20","doi-asserted-by":"publisher","first-page":"842454","DOI":"10.3389\/fped.2022.842454","article-title":"Hydromorphone prescription for pain in children-what place in clinical practice?","volume":"10","author":"Rodieux","year":"2022","journal-title":"Front Pediatr"},{"key":"B21","doi-asserted-by":"publisher","first-page":"473","DOI":"10.4097\/kja.22279","article-title":"Erector spinae plane block in children: a narrative review","volume":"75","author":"Lucente","year":"2022","journal-title":"Korean J Anesthesiol"},{"key":"B22","doi-asserted-by":"publisher","first-page":"111861","DOI":"10.1016\/j.jclinane.2025.111861","article-title":"Erector spinae plane block for analgesia in children undergoing surgery: a systematic review, meta-analysis and trial sequential analysis","volume":"104","author":"Oliveira","year":"2025","journal-title":"J Clin Anesth"},{"key":"B23","doi-asserted-by":"publisher","first-page":"934","DOI":"10.1097\/ALN.0b013e31828866b3","article-title":"Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures","volume":"118","author":"Gerbershagen","year":"2013","journal-title":"Anesthesiology"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1187","DOI":"10.1111\/pan.12271","article-title":"A retrospective study of multimodal analgesic treatment after laparoscopic appendectomy in children","volume":"23","author":"Liu","year":"2013","journal-title":"Paediatr Anaesth"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1395","DOI":"10.1111\/anae.13234","article-title":"A randomised controlled trial of bilateral dual transversus abdominis plane blockade for laparoscopic appendicectomy","volume":"70","author":"Tanggaard","year":"2015","journal-title":"Anaesthesia"},{"key":"B26","doi-asserted-by":"publisher","first-page":"974","DOI":"10.14744\/tjtes.2021.68927","article-title":"Effects of intraperitoneal bupivacaine injection in laparoscopic appendectomy in children on post-operative pain: a controlled randomized double-blinded study","volume":"28","author":"Erg\u00fcn","year":"2022","journal-title":"Ulus Travma Acil Cerrahi Derg"},{"key":"B27","doi-asserted-by":"publisher","first-page":"998","DOI":"10.1213\/ANE.0b013e3181ee7bba","article-title":"Ipsilateral transversus abdominis plane block provides effective analgesia after appendectomy in children: a randomized controlled trial","volume":"111","author":"Carney","year":"2010","journal-title":"Anesth Analg"},{"key":"B28","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1016\/j.accpm.2018.03.008","article-title":"Ultrasound-guided bilateral erector spinae plane block could provide effective postoperative analgesia in laparoscopic cholecystectomy in paediatric patients","volume":"38","author":"Aksu","year":"2019","journal-title":"Anaesth Crit Care Pain Med"},{"key":"B29","doi-asserted-by":"publisher","first-page":"209","DOI":"10.14744\/agri.2019.88896","article-title":"Efficacy of ultrasound-guided bilateral erector spinae plane block in pediatric laparoscopic cholecystectomy: case series","volume":"31","author":"Karaca","year":"2019","journal-title":"Agri"},{"key":"B30","doi-asserted-by":"publisher","first-page":"4393","DOI":"10.1097\/JS9.0000000000001421","article-title":"Analgesia efficacy of erector spinae plane block in laparoscopic abdominal surgeries: a systemic review and meta-analysis","volume":"110","author":"Sia","year":"2024","journal-title":"Int J Surg"},{"key":"B31","doi-asserted-by":"publisher","first-page":"389","DOI":"10.1186\/s12871-024-02775-4","article-title":"Erector spinae plane block for laparoscopic surgeries: a systematic review and meta-analysis","volume":"24","author":"Oraee","year":"2024","journal-title":"BMC Anesthesiol"},{"key":"B32","doi-asserted-by":"publisher","first-page":"1165","DOI":"10.1007\/s12630-018-1187-y","article-title":"Mechanism of the erector spinae plane block: insights from a magnetic resonance imaging study","volume":"65","author":"Schwartzmann","year":"2018","journal-title":"Can J Anaesth"},{"key":"B33","doi-asserted-by":"publisher","first-page":"1244","DOI":"10.1111\/anae.14408","article-title":"Comparison of injectate spread and nerve involvement between retrolaminar and erector spinae plane blocks in the thoracic region: a cadaveric study","volume":"73","author":"Yang","year":"2018","journal-title":"Anaesthesia"},{"key":"B34","doi-asserted-by":"publisher","first-page":"942","DOI":"10.1007\/s12630-020-01613-8","article-title":"A magnetic resonance imaging study of local anesthetic spread in patients receiving an erector spinae plane block","volume":"67","author":"Schwartzmann","year":"2020","journal-title":"Can J Anaesth"},{"key":"B35","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1097\/AAP.0000000000000789","article-title":"A cadaveric study investigating the mechanism of action of erector spinae blockade","volume":"43","author":"Ivanusic","year":"2018","journal-title":"Reg Anesth Pain Med"},{"key":"B36","doi-asserted-by":"publisher","first-page":"640","DOI":"10.1136\/rapm-2020-101523","article-title":"Evaluating the extent of lumbar erector spinae plane block: an anatomical study","volume":"45","author":"Harbell","year":"2020","journal-title":"Reg Anesth Pain Med"},{"key":"B37","doi-asserted-by":"publisher","first-page":"886","DOI":"10.1007\/s12630-019-01399-4","article-title":"Anatomical evaluation of the extent of spread in the erector spinae plane block: a cadaveric study","volume":"66","author":"Aponte","year":"2019","journal-title":"Can J Anaesth"},{"key":"B38","doi-asserted-by":"publisher","first-page":"667","DOI":"10.1111\/pan.13864","article-title":"The extent of cranio-caudal spread within the erector spinae fascial plane space using computed tomography scanning in a neonatal cadaver","volume":"30","author":"Govender","year":"2020","journal-title":"Paediatr Anaesth"},{"key":"B39","doi-asserted-by":"publisher","first-page":"386","DOI":"10.1136\/rapm-2019-100985","article-title":"A cadaveric study of the erector spinae plane block in a neonatal sample","volume":"45","author":"Govender","year":"2020","journal-title":"Reg Anesth Pain Med"},{"key":"B40","doi-asserted-by":"publisher","first-page":"e447","DOI":"10.1097\/j.pain.0000000000003631","article-title":"Psychosocial mechanisms underlying the transition from acute to chronic postsurgical pain in youth following spinal fusion: a 6-month longitudinal study","volume":"166","author":"Li","year":"2025","journal-title":"Pain"},{"key":"B41","doi-asserted-by":"publisher","first-page":"874","DOI":"10.1016\/j.jopan.2023.12.025","article-title":"Determination of risk factors for nausea and vomiting in children after appendectomy","volume":"39","author":"Naz","year":"2024","journal-title":"J Perianesth Nurs"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1803495\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T05:36:26Z","timestamp":1777613786000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1803495\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,1]]},"references-count":41,"alternative-id":["10.3389\/fped.2026.1803495"],"URL":"https:\/\/doi.org\/10.3389\/fped.2026.1803495","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,1]]},"article-number":"1803495"}}