Efficacy and Safety Profile of Rectus Sheath Block in Adult Laparoscopic Surgery: A Meta-analysis

Hamid, Hytham K. S.; Ahmed, Amjed Y.; Alhamo, Manhl A.; Davis, George N.

doi:10.1016/j.jss.2020.12.003

Cited by 29 publications

(49 citation statements)

References 28 publications

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“…TAP blocks provide analgesia from T10 to L1, i.e., below the umbilicus while subcostal and rectus blocks prove useful adjuncts to provide a block for the upper abdomen. Recent systematic reviews have shown that TAP blocks have shown reduced opioid consumption, earlier return of bowel function and shorter LOS in abdominal and gynecologic surgery [ 82 , 83 ]. A concern is the short duration (8–10 h) of TAP blocks.…”

Section: Resultsmentioning

confidence: 99%

Guidelines for Perioperative Care in Elective Abdominal and Pelvic Surgery at Primary and Secondary Hospitals in Low–Middle‐Income Countries (LMIC's): Enhanced Recovery After Surgery (ERAS) Society Recommendation

et al. 2022

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Background This is the first Enhanced Recovery After Surgery (ERAS®) Society guideline for primary and secondary hospitals in low–middle-income countries (LMIC’s) for elective abdominal and gynecologic care. Methods The ERAS LMIC Guidelines group was established by the ERAS® Society in collaboration with different representatives of perioperative care from LMIC’s. The group consisted of seven members from the ERAS® Society and eight members from LMIC’s. An updated systematic literature search and evaluation of evidence from previous ERAS® guidelines was performed by the leading authors of the Colorectal (2018) and Gynecologic (2019) surgery guidelines (Gustafsson et al in World J Surg 43:6592–695, Nelson et al in Int J Gynecol Cancer 29(4):651–668). Meta-analyses randomized controlled trials (RCTs), prospective and retrospective cohort studies from both HIC’s and LMIC’s were considered for each perioperative item. The members in the LMIC group then applied the current evidence and adapted the recommendations for each intervention as well as identifying possible new items relevant to LMIC’s. The Grading of Recommendations, Assessment, Development and Evaluation system (GRADE) methodology was used to determine the quality of the published evidence. The strength of the recommendations was based on importance of the problem, quality of evidence, balance between desirable and undesirable effects, acceptability to key stakeholders, cost of implementation and specifically the feasibility of implementing in LMIC’s and determined through discussions and consensus. Results In addition to previously described ERAS® Society interventions, the following items were included, revised or discussed: the Surgical Safety Checklist (SSC), preoperative routine human immunodeficiency virus (HIV) testing in countries with a high prevalence of HIV/AIDS (CD4 and viral load for those patients that are HIV positive), delirium screening and prevention, COVID 19 screening, VTE prophylaxis, immuno-nutrition, prehabilitation, minimally invasive surgery (MIS) and a standardized postoperative monitoring guideline. Conclusions These guidelines are seen as a starting point to address the urgent need to improve perioperative care and to effect data-driven, evidence-based care in LMIC’s.

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Section: Resultsmentioning

confidence: 99%

Guidelines for Perioperative Care in Elective Abdominal and Pelvic Surgery at Primary and Secondary Hospitals in Low–Middle‐Income Countries (LMIC's): Enhanced Recovery After Surgery (ERAS) Society Recommendation

et al. 2022

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“…In particular, the rectus sheath block was not statistically significant for any of the investigated outcomes while intraperitoneal instillation of local anesthetics and wounds/ports infiltration was consistently among the least effective treatments. A recent meta -analysis investigating the effect of the rectus sheath block on various laparoscopic surgeries [13] found the technique to be effective on pain scores for both the second and the composite tenth -twelfth postoperative hours, while the block was not effective when considering the twentyfourth postoperative hour. A limitation of this study relates to the inclusion of several different types of laparoscopic procedure (with the majority being gynecological interventions).…”

Section: Discussionmentioning

confidence: 99%

“…Many meta -analysis evaluate different regional anesthesia techniques for postoperative pain and analgesia requirements in LC [2,[9][10][11][12][13]. Herein, we have designed and conducted a systematic review and meta -analysis of all randomized controlled -comparative studies that have evaluated the effect of regional anesthesia techniques, including infiltration, in LC.…”

Section: Introductionmentioning

confidence: 99%

Single-shot regional anesthesia for laparoscopic cholecystectomies: a systematic review and network meta-analysis

Cassai

Sella

Geraldini

et al. 2023

Korean J Anesthesiol

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“…Hariharan et al [ 20 ] reported a bilateral URSB for a single-incision laparoscopic tubal ligation without general anesthesia in a cardiac patient. A recent meta-analysis (2021) reported that URSB could improve pain control for up to 12 h postoperatively and reduce opioid consumption without major adverse events among adults receiving laparoscopic surgery in both the inpatient and outpatient settings [ 21 ]. The effective dose of URSB varied from 75 to 100 mg of bupivacaine (0.5% 20 ml and 0.25% 40 ml) [ 9 , 22 ] and ropivacaine (0.25% 30 ml and 0.5% 20 ml) [ 17 – 19 ], which were much higher than in our study.…”

Section: Discussionmentioning

confidence: 99%

Minimal effective dose of ultrasound-guided rectus sheath block to reduce oral analgesic requirement after ambulatory laparoscopic tubal resection: a randomized controlled superiority trial

Siripruekpong

Aphinyankul

Chanchayanon

et al. 2022

Trials

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Background The effective dose during ultrasound-guided rectus sheath block (URSB) for reducing pain after laparoscopic tubal ligation is reported to be 100 mg of 0.25% bupivacaine. We examined the minimal effective dose of 0.25% bupivacaine for URSB on oral analgesic requirement after ambulatory single-port laparoscopic tubal resection. Methods A prospective, randomized controlled, superiority trial was conducted among patients who had been scheduled for ambulatory laparoscopic tubal resection between September 2015 and January 2019 at a tertiary care hospital in southern Thailand. Anesthesia was induced following protocol. The intervention group was allocated to receive a bilateral URSB using 10 ml of 0.25% bupivacaine on either side after intubation (total 50 mg) while the control group did not receive the sham block. Patients and assessors were blinded to the study intervention. All patients received a multimodal analgesia regimen as follows: fentanyl and ketorolac intraoperatively and fentanyl and oral acetaminophen at the post-anesthetic care unit. Postoperative oral analgesic requirement (acetaminophen and/or ibuprofen) at home was the primary outcome. Postoperative time to first analgesic requirement, oral analgesia (acetaminophen/ibuprofen), and pain score at 6 and 24 h were accessed via telephone interviews. Percentage, effect size (ES), and 95% confidence interval (CI) were presented. Results A total of 66 out of 79 eligible patients were analyzed (32 intervention, 34 control). Intraoperative fentanyl consumption was significantly lower in the intervention group (ES [95% CI]: 0.58 [0.08, 1.07] mcg, p = 0.022). Time to first oral analgesia in the intervention group was significantly longer than that of the control group (ES [95% CI]: 0.66 [0.14, 1.16] h, p = 0.012). The proportion of oral analgesia requirement at 24 h after surgery in the control group was significantly higher than that in the intervention group (97% vs 75%, p = 0.012). Pain scores at 6 and 24 h were similar in both groups although slightly lower in the intervention group (ES [95% CI]: 0.22 [−0.26, 0.71], p = 0.368 and 0.33 [−0.16, 0.81], p = 0.184, respectively). Conclusion A dose of 0.25% bupivacaine 50 mg for URSB reduced the oral analgesic requirement at 24 h and prolonged the time to first analgesic requirement after ambulatory laparoscopic tubal resection. Trial registration Thaiclinicaltrials.orgTCTR20150921002. Registered on 18 September 2015

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Efficacy and Safety Profile of Rectus Sheath Block in Adult Laparoscopic Surgery: A Meta-analysis

Cited by 29 publications

References 28 publications

Guidelines for Perioperative Care in Elective Abdominal and Pelvic Surgery at Primary and Secondary Hospitals in Low–Middle‐Income Countries (LMIC's): Enhanced Recovery After Surgery (ERAS) Society Recommendation

Guidelines for Perioperative Care in Elective Abdominal and Pelvic Surgery at Primary and Secondary Hospitals in Low–Middle‐Income Countries (LMIC's): Enhanced Recovery After Surgery (ERAS) Society Recommendation

Single-shot regional anesthesia for laparoscopic cholecystectomies: a systematic review and network meta-analysis

Minimal effective dose of ultrasound-guided rectus sheath block to reduce oral analgesic requirement after ambulatory laparoscopic tubal resection: a randomized controlled superiority trial

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