{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T03:32:36Z","timestamp":1761535956552,"version":"build-2065373602"},"reference-count":17,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,10,25]],"date-time":"2025-10-25T00:00:00Z","timestamp":1761350400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: Abdominal aortic aneurysms (AAAs) are exceedingly rare in pediatric patients but carry a significant risk of rupture, necessitating urgent surgical repair. Postoperative pain management following open AAA repair is particularly challenging and ultrasound-guided rectus sheath blocks (RSBs) offer a targeted and lower-risk alternative for midline abdominal incisions. Methods: We present an 8-year-old male who underwent open infrarenal AAA repair. Multilevel bilateral ultrasound-guided RSBs were performed at T7, the umbilicus and T12 using a mixture of liposomal bupivacaine, bupivacaine, and dexamethasone preservative free (PF). Results: Postoperative pain scores remained consistently low through postoperative day (POD) 6, with minimal opioid requirements. Functional recovery was rapid, with sitting achieved by POD 1 and ambulation by POD 2. Plasma bupivacaine concentrations remained within safe limits throughout hospitalization. Conclusions: Multilevel bilateral RSBs with liposomal bupivacaine, bupivacaine, and dexamethasone PF provided prolonged opioid-sparing analgesia, facilitated early mobilization, and supported enhanced recovery in this complex pediatric surgical case.<\/jats:p>","DOI":"10.3390\/children12111450","type":"journal-article","created":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T02:50:48Z","timestamp":1761533448000},"page":"1450","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Ultrasound-Guided Multilevel Bilateral Rectus Sheath Blocks with Liposomal Bupivacaine, Bupivacaine, and Dexamethasone PF for Postoperative Pain Management After a Pediatric Abdominal Aortic Aneurysm Repair"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-3858-8069","authenticated-orcid":false,"given":"Tyler H.","family":"Augi","sequence":"first","affiliation":[{"name":"School of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0933-4536","authenticated-orcid":false,"given":"Mihaela","family":"Visoiu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, UPMC Children\u2019s Hospital of Pittsburgh, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1177\/15266028231179419","article-title":"Systematic Review With Meta-Analysis of Endovascular Versus Open Repair of Abdominal Aortic Aneurysm Repair in the Young","volume":"32","author":"Kontopodis","year":"2025","journal-title":"J. Endovasc. Ther."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Byun, E., Kwon, T.-W., Kim, H., Cho, Y.P., Han, Y., Ko, G.Y., and Jeong, M.-J. (2021). Quality-adjusted life year comparison at medium-term follow-up of endovascular versus open surgical repair for abdominal aortic aneurysm in young patients. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0260690"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1177\/1526602815606937","article-title":"Endovascular vs Open Aneurysm Repair in the Young: Systematic Review and Meta-analysis","volume":"22","author":"Kontopodis","year":"2015","journal-title":"J. Endovasc. Ther."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.jvs.2017.10.044","article-title":"The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm","volume":"67","author":"Chaikof","year":"2018","journal-title":"J. Vasc. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1016\/j.jvs.2019.12.039","article-title":"The evolution of open abdominal aortic aneurysm repair at a tertiary care center","volume":"72","author":"Fairman","year":"2020","journal-title":"J. Vasc. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1053\/j.jvca.2024.12.028","article-title":"Pain Management in Open Abdominal Aortic Aneurysm Repair: Potential Alternatives to Epidural Anesthesia","volume":"39","author":"Yoshida","year":"2025","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.avsg.2023.04.012","article-title":"Rectus Sheath Block Improves Patient Recovery Following Open Aortic Surgery","volume":"97","author":"Cleary","year":"2023","journal-title":"Ann. Vasc. Surg."},{"key":"ref_8","first-page":"CD011419","article-title":"Liposomal bupivacaine infiltration at the surgical site for the management of postoperative pain","volume":"2","author":"Hamilton","year":"2017","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1354","DOI":"10.1016\/j.clinthera.2015.03.017","article-title":"Evolving Role of Local Anesthetics in Managing Postsurgical Analgesia","volume":"37","author":"Golembiewski","year":"2015","journal-title":"Clin. Ther."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1055\/s-0043-121142","article-title":"Bupivacaine Versus Liposomal Bupivacaine For Pain Control","volume":"68","author":"Beiranvand","year":"2018","journal-title":"Drug Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1111\/pan.13561","article-title":"Incidence of adverse events attributable to bupivacaine liposome injectable suspension or plain bupivacaine for postoperative pain in pediatric surgical patients: A retrospective matched cohort analysis","volume":"29","author":"Cohen","year":"2019","journal-title":"Pediatr. Anesth."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"110503","DOI":"10.1016\/j.jclinane.2021.110503","article-title":"A multicenter study to evaluate the pharmacokinetics and safety of liposomal bupivacaine for postsurgical analgesia in pediatric patients aged 6 to less than 17 years (PLAY)","volume":"75","author":"Tirotta","year":"2021","journal-title":"J. Clin. Anesth."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e70112","DOI":"10.1111\/petr.70112","article-title":"Liposomal Bupivacaine in Single-Injection Quadratus Lumborum Block for Pediatric Kidney Transplant: Case Report of a Novel Application","volume":"29","author":"Bonaroti","year":"2025","journal-title":"Pediatr. Transplant."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1111\/pan.13577","article-title":"Single injection ultrasound-guided rectus sheath blocks for children: Distribution of injected anesthetic","volume":"29","author":"Visoiu","year":"2019","journal-title":"Pediatr. Anesth."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1177\/0310057X1103900220","article-title":"Audit of initial use of the ultrasound-guided transversus abdominis plane block in children","volume":"39","author":"Palmer","year":"2011","journal-title":"Anaesth. Intensive Care"},{"key":"ref_16","first-page":"376","article-title":"Dexamethasone has a synergistic effect on liposomal bupivacaine in reducing postoperative pain after total shoulder arthroplasty","volume":"5","author":"Wier","year":"2025","journal-title":"JSES Rev. Rep. Tech."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3283","DOI":"10.1111\/bph.15800","article-title":"Postoperative ileus: A pharmacological perspective","volume":"179","author":"Buscail","year":"2022","journal-title":"Br. J. Pharmacol."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/11\/1450\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T03:28:52Z","timestamp":1761535732000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/11\/1450"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,25]]},"references-count":17,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["children12111450"],"URL":"https:\/\/doi.org\/10.3390\/children12111450","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,25]]}}}