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.
