Rectus sheath block for postoperative analgesia in patients with mesenteric vascular occlusion undergoing laparotomy: A randomized single-blinded study

Abstract

Background:Acute mesenteric ischemia is a life-threatening vascular emergency that requires early diagnosis, immediate anticoagulation, and intervention to restore mesenteric blood flow adequately.Aims:To investigate the effect of rectus sheath block (RSB) for postoperative analgesia in patients with mesenteric vascular occlusion.Settings and Design:Forty patients with mesenteric vascular occlusion, American Society of Anesthesiologists physical status I or II or III, scheduled for laparotomy were enrolled in this study.Subjects and Methods:Patients were randomized into two groups; control group (C Group) and rectus block group (RB Group). In both groups, general anesthesia was induced fentanyl 1 μg/kg with sleeping dose of propofol and 0.15 mg/kg cisatracurium. Then, anesthesia was maintained with sevoflurane in oxygen 100%. In RB Group, under aseptic condition, RSB guided by ultrasound was performed. Surgery is then continued and intravenous fentanyl patient-controlled analgesia pump started. Postoperative pain, sedation, and opioid side effects were assessed.Statistical Analysis Used:Statistical analysis was done using Statistical Package for Social Sciences (SPSS 19.0, Chicago, IL, USA).Results:Patients in the RB Group consumed statistically significant less opioid in comparison to control group either intraoperatively or postoperatively. Mean pain scores were statistically significant less in RB Group than in the control group at 2, 4, and 6 h postoperatively. Sedation score, incidence of nausea and vomiting were statistically significant less in the RB Group in comparison to control group. More patients’ satisfaction was reported in the RB Group.Conclusions:Ultrasound-guided RSB resulted in postoperative reduction of pain scores and opioid consumption compared with general anesthesia alone. Moreover, RSB was associated with better patient satisfaction and less nausea and vomiting.

Comparison of postoperative analgesia and opioid requirement with thoracic epidural vs. continuous rectus sheath infusion in midline incision laparotomies under general anaesthesia – A prospective randomised controlled study

“…They reported lower opioid consumption (both intra-operative and post-operative) and lower pain scores in patients who received single-shot RSB than those with general anaesthesia alone for abdominal surgeries, in adults and children, respectively. [ 2 9 ] A meta-analysis further supported and established RSB to be an effective analgesic technique in terms of reduced opioid requirement and pain scores in paediatric population. [ 10 ]…”

“…The use of ultrasound for the insertion of an infusion catheter can prolong the analgesic effect by continuous infusion of local anaesthetic (LA). [ 2 ]…”

Research on the efficacy of the rectus sheath block method

“…Although their analgesic effects are strong, side effects like respiratory depression, sedation, nausea, vomiting, constipation, bradycardia, hypotension and itching can be seen related to their usage. [17,18] In their study, Elbahrawy et al [19] investigated the effect of rectus sheath block on postoperative VAS, and reported that average VAS scores in rectus sheath block group was significantly lower than the control group. In a study by Halefoglu et al [20] including pediatric patients with transverse incision laparotomy; they reported that rectus sheath block significantly lowers postoperative pain score (FLACC score).…”

“…Rectus sheath block is a nerve blocking method used as a postoperative analgesia method, which should reduce the need for analgesics after surgery, and there are many studies in the literature which support this. For example Elbahrawy et al [19] reported that intraoperative and postoperative opioid consumption was significantly lower in patients who received rectus sheath block compared to the control group.…”

“…[22] In studies involving rectus sheath block used as a postoperative analgesic method, the postoperative side effect difference of reduced opioid consumption has been assessed. In a study, Elbahrawy et al [19] investigated sedation scores and nausea and vomiting incidences and reported that nausea and vomiting incidence was significantly lower in patients with rectus sheath block compared to patients with only general anaesthesia. They also observed, that most of the patients, who expressed satisfaction, had a rectus sheath block application.…”