Comparision of analgesic efficacy of ropivacaine and bupivacaine in rectus sheath block for midline abdominal surgeries

Abstract

Background: In the modern setting the rectus sheath block (RSB) has been found effective in decreasing opioid requirement after both diagnostic and interventional laparoscopy and laparotomy. Efficacy of rectus sheath block (RSB) using ropivacaine versus bupivacaine for acute postoperative pain relief is not much investigated. Material and Methods: 90 patients undergoing elective midline abdominal surgeries under general anaesthesia were randomly divided into three groups of 30 patients each, destined to receive bilateral rectus sheath block using 15 ml on each side (total 30 ml) of 0.25% ropivacaine in Group R, 0.25% bupivacaine in Group B or normal saline in Group C. Three groups were compared regarding time to first rescue analgesic from time of RSB (duration of analgesia), total rescue analgesic (tramadol) consumption in first 10 hours, visual analogue score (VAS), satisfaction score and adverse effects. Result: Mean duration of analgesia was significantly longer in group R (5.78±0.93h) than group B (3.63±0.90 h) and group C (2.37±0.44 h), p<0.001 (group R > group B > group C). This trend was observed in both hernia repair and laparotomy. Rescue analgesic consumption in terms of number of doses was significantly less in Group R (30) than in Group B (38) than in Group C (59), p<0.05. Mean VAS was significantly less and patient satisfaction was significantly better in Group R than in Group B than in Group C, (p<0.001). Conclusion: Bilateral single shot rectus sheath block (RSB) using isobaric ropivacaine (0.25%) or bupivacaine (0.25%) is a safe and effective method of providing postoperative analgesia to patients undergoing midline abdominal surgeries. The lower cardio toxicity profile with the excellent prolonged postoperative analgesia makes ropivacaine an excellent choice for the RSB as compared to bupivacaine.

Comparison of the effectiveness of thoracic epidural and rectus sheath catheter as analgesic modalities following laparotomy: A systematic review and meta-analysis

“…A key difference between the two included RCT studies is that Yassin et al’s (2017) study adopted intermittent infusion of bupivacaine for RSCs group, which contrasts the continuous infusion of ropivacaine implemented in Gupta et al’s (2020) trial. Continuous ropivacaine infusion is a newer technique with favourable side effect profile; Gupta et al’s (2020) findings may be more applicable to future practice (Kuldeep et al 2020).…”