Efficacy of ultrasound-guided rectus sheath block, butorphanol for single-incision laparoscopic cholecystectomy: A prospective, randomized, clinical trial

Abstract

Background: Whether rectus sheath block (RSB) combined with butorphanol can relieve incisional pain and visceral pain in patients undergoing single-incision laparoscopic cholecystectomy (SILC) remains unknown. The goal of this study was to assess the efficacy of ultrasound-guided bilateral RSB, and butorphanol for postoperative analgesia in patients undergoing SILC.Methods: All 116 patients who met the criteria were randomly divided into four groups: group I, (n=29) general anaesthesia combined with patient-controlled intravenous analgesia (PCIA) (sufentanil 1 µg/ml); group II, (n=29) general anaesthesia combined with PCIA (butorphanol 0. 08 µg/ml); group III, (n=29) ultrasound-guided RSB (ropivacaine 100 mg) combined with PCIA (sufentanil 1 µg/ml); and group IV, (n=29) ultrasound-guided RSB (ropivacaine 100 mg) combined with PCIA (butorphanol 0.08 µg/ml). Outcomes included visual analogue scale (VAS) scores (0-10) of incisional pain (defined as superficial pain on the abdominal wall) and visceral pain (defined as deep, dull pain within the abdomen) at rest and during cough at 2,6,12 and 24 h postoperatively, the dose of butorphanol and sufentanil, the number of PCIA presses, the length of hospital stay and the incidence of postoperative adverse events. Results: Both the rest and cough incisional pain scores were lower during the first 2 and 6 h in group Ⅲ than in group Ⅰ (P＜0.05). Similarly, scores in group Ⅳ were significantly lower than those in group II (P＜0.05). Patients in group I needed more butorphanol as a rescue analgesic for pain relief than did those in group III, and patients in group IV needed less butorphanol as a rescue analgesic for pain relief than did those in group II. From the above pairwise comparisons, it is clear that groups III and IV had lower VAS scores. The VAS scores for visceral pain were lower in group II at 2, 6 and 12 h after surgery than in group I and lower in group IV than in group Ⅲ. Overall, ultrasound-guided RSB combined with PCIA (butorphanol 0. 08 µg/ml) performed the best. Conclusions: Ultrasound-guided RSB combined with butorphanol can provide sufficient pain treatment after SILC than can general anaesthesia combined with sufentanil.