Efficacy of combined ultrasound guided anterior and posterior rectus sheath block for postoperative analgesia following umbilical hernia repair: Randomized, controlled trial

Abstract

Background: Anatomical variations in the thoracic nerves T7 to T11was found in up to 30% of the population as the anterior cutaneous branch of the nerves are formed before the rectus sheath and so do not penetrate the posterior wall of the rectus sheath. Posterior rectus sheath block was found to be effective for perioperative analgesia. We tested the efficacy of addition of anterior rectus sheath block to capture the anterior cutaneous branch of intercostal nerves as they emerge from the rectus muscle in anterior rectus sheath. Method: Sixty-three ASA I/II adult patients listed for elective umbilical hernia repair were randomly allocated in one of three groups: Bupivacaine hydrochloride 0.25% was injected by ultrasound guided bilateral posterior rectus sheath in Group I (PRSB) and bilateral anterior and posterior rectus sheath in Group II (APRSB). Group III received bilateral anterior and posterior rectus sheath block using isotonic saline. Twenty-four hours postopetrative morphine consumption, Intraoperative rescue fentanyl dose, equivalent morphine dose in the recovery unit and first morphine dose were recorded. The quality of analgesia is assessed by Visual Analogue Scale for 24 h.Results: Mean intraoperative rescue fentanyl dose was 19.23 ± 4.96 lg, 15.28 ± 2.75 lg and 12.85 ± 3.65 lg in control, PRSB and APRSB groups respectively (P < 0.001). The mean opioid consumptions in PACU was PRSB 3.47 ± 0.13 mg, APRSB 2.91 ± 0.15 mg and control 4.04 ± 0.56 mg respectively (P < 0.001). Significant difference in intraoperative rescue fentanyl was found between PRSB and APRSB group (P = 0.020). Also statistically significant difference was found between PRSB and APRSB groups in 24 h morphine consumption (P = 0.034). Conclusion: Addition of ultrasound anterior rectus sheath block together with posterior rectus sheath block added more significant analgesia than if we perform posterior rectus sheath alone. This was evidenced by decrease in Intraoperative rescue fentanyl, PACU morphine analgesia, 24 h morphine and pain assessment score.

Rectus Sheath Block Efficacy for Patients Who Underwent Emergency Midline Laparotomy at a Resource Limited Setting in Northcentral Ethiopia, 2019.

“…In line with our ndings, studies showed that BRSB is effective in reducing the severity of postoperative pain score, analgesics consumption and increases time to rst analgesic request [24][25][26][27]. While other studies failed to demonstrate BRSB effectiveness [28,29].…”

The advantage of hyaluronidase in rectus sheath block for pain control in laparoscopic cholecystectomy

“…The current study has demonstrated the efficacy of adding hyaluronidase to bupivacaine in RSB that significantly lower intraoperative fentanyl consumption in group H than group B (167.75±20.6and 186.25±20.57 ug) respectively. In a study done by Ibrahim et al 13 , the authors reported that the mean intraoperative fentanyl dose was (19.23 ± 4.96 ug), (15.28 ± 2.75 ug) in the control group, and posterior rectus sheath block (PRSB) respectively(P < 0.001) 11 . Kasem & AbdelKader have reported no statistically significant difference between the R group (RSB) and the L (local infiltration) group concerning the total amount of fentanyl consumption intraoperatively (168 ± 28 and 174 ± 36 μg, respectively) 14 .…”

“…Bilateral posterior RSB is used for postoperative pain control, including laparoscopy, umbilical hernia, pediatric, and gynecological surgery. It provides dense and predictable analgesia over the central area of the ventral abdominal wall from the xiphisternum to the symphysis pubis 13 . Recently many studies have searched the effect of adding hyaluronidase to the different local anesthetic mixtures as an adjuvant in some regional blocks.…”

“…So, it can be relied upon in this study, based on this assumption, sample size was calculated according to these values produced a minimal samples size of 80 cases were enough to find such a difference, subdivided into two groups 40 patients in each group. 7 Methods of randomization: the randomization of patients was using a computerized program (SPSS), while sealed envelopes was numbered according to the randomization tables, than Packing, sealing and numbering of the envelope was performed by a neutral medical personnel (Under the supervision of doctors from the Department), the number of cases included in this study was simple randomly allocated into two groups.…”

Comparison of Ultrasound-Guided Rectus Sheath Block Versus Local Infiltration at The Port Sites and Intraperitoneal Instillation of 0.25% Bupivacaine for Post-Operative Pain Control After Laparoscopic Cholecystectomy

“…Bilateral RSB is used to reduce postoperative pain after laparoscopic, pediatric, gynecological, and umbilical hernia surgery. It gives better analgesia over the core portion of the ventral abdominal wall from the xiphisternum to the symphysis pubis [11] . There were differences in age, sex, and weight across the groups, but they were not statistically significant.…”