Title: A Comparative Study of Ultrasound Guided Bilateral Rectus Sheath Block versus Local Incision Site Infiltration for Post Operative Analgesia in Patients Undergoing Laparotomy with Midline Incision
Authors: Sunil Kumar Sah, Richeek Kumar Pal, Subhrajyoti Chattopadhyay
DOI: https://dx.doi.org/10.18535/jmscr/v8i1.67
Abstract
Background: Good postoperative pain management is effective in reducing perioperative opioid consumption and thereby reducing perioperative morbidity. Ultrasound guided rectus sheath block to decrease postoperative pain makes this block more reproducible and reduces the risk of inadvertent peritoneal and vascular punctures. Local incision site infiltration at the end of surgery also decreases postoperative pain significantly. Therefore the study was planned to compare efficacies of the two techniques in cases of laparotomy with midline incision.
Methods: Eighty adult patients aged between 18-60 years of age, American Society of Anaesthesiologists (ASA) physical status 1 and 2, undergoing laparotomy with midline incision under general anaesthesia, were randomly allocated to receive either ultrasound guided bilateral rectus sheath block(Group R, n=40) or local incision site infiltration(Group I, n=40) with same local anaesthetic, i.e. Levobupivacaine 0.25%. Time to receive first rescue analgesia postoperatively, Visual Analogue Scale score (VAS) at different point of time postoperatively, total postoperative analgesic consumption and any adverse effects postoperatively were noted.
Results: There was significant (p<0.05) reduction of pain in group of patients receiving USG guided RSB at 2nd, 6th, 12th & 24th postoperative hours assessed by VAS. There was also significant reduction (p=0.000) in total fentanyl consumption in groups receiving US guided bilateral RSB during the first 24 hours and patients receiving local incision site infiltration required analgesic much earlier than the patients receiving RSB. There was also significant decrease in PONV during the first 2 & 6 hours postoperatively in patients receiving Rectus sheath block and the patient satisfaction score in our study was better in patients receiving RSB (p=0.000).
Conclusion: Ultrasound guided rectus sheath block seemed to be superior in providing postoperative analgesia. There were also reduced incidences of postoperative nausea and vomiting during the first 2 and 6 hours postoperatively compared with the incision site infiltration group.
Keywords: Analgesia, Infiltration, Laparotomy, Levobupivacaine, Rectus sheath block, Ultrasound.
References
- Yeager MP, Glass DD, Neff RK. Epidural anesthesia and analgesia in high-risk surgical patients. Anesthesiology 1987;66:729.
- Tuman KJ, McCarthy RJ, March RJ. Effects of epidural anesthesia and analgesia on coagulation and outcome after major vascular surgery. Anesth Analg 1991;73:696.
- Scott NB. Wound infiltration for surgery. Anaesthesia 2010; 65(Suppl 1):67-75.
- Brower MC, Johnson ME. Adverse effects of local anesthetic infiltration on wound healing. Reg Anesth Pain Med 2003;28:233-40.
- Dolan J, Lucie P, Geary T, Smith M, Kenny GN. The rectus sheath block: accuracy of local anaesthetic placement by trainee anaesthesiologists using loss of resistance of ultrasound guidance. Reg Anaesth Pain Med 2009;34:247-50.
- Fitzpatrick CL, Weir HL, Monnet E. Effects of infiltration of the incision site with bupivacaine on postoperative pain and incisional healing in dogs undergoing ovariohysterectomy. J Am Vet Med Assoc 2010;237:395-401.
- Ivani G, De Negri P, Lonnqvist PA, L‟Erario M, Mossetti V, Difilippo A, et al. Caudal anesthesia for minor paediatric surgery: a prospective randomized comparison of ropivacaine 0.2% vs levobupivacaine 0.2%. Pediatric Anesth 2005;15:491-4.
- Willschke H, Bosenberg A, Marhofer P, et al. Ultrasonography-guided rectus sheath block in paediatric anaesthesia- a new approach to an old technique. Br J Anaesth 2006;97:244-9.
- J Yarwood, A Berrill, Nerve blocks of the anterior abdominal wall. Continuing Education in Anaesthesia Critical Care & Pain 2010;10(6):182-6.
- Gurnaney HG, Maxwell LG, Kraemer FW, Goebel T, Nance ML, Ganesh A, et al. Prospective randomized observer-blinded study comparing the analgesic efficacy of ultrasound guided rectus sheath block and local anaesthetic infiltration for umbilical hernia repair. Br J Anaesth. 2011;107:790-5.
- Dingeman RS, Barus LM, Chung HK, Clendenin DJ, Lee CS, Tracy S, et al. Ultrasonography-guided bilateral rectus sheath block vs local anaesthetic infiltration after paediatric umbilical hernia repair: a prospective randomized clinical trial. JAMA surg.2013;148:707-13.
- Saxena R, Joshi S, Srivastava K, Tiwari S, Sharma N, Valecha UK, et al. Comparative study of ultrasound-guided abdominal field blocks versus port infiltration in laparoscopic cholecystectomies for post-operative pain relief. Indian J Anaesth 2016;60:578-83