Ultrasound guided bilateral rectus sheath block and serum TNF-α and IL-6 after radical prostatectomy: A randomized double blinded study

Abstract

Background: General anesthesia can affect postoperative cytokine levels, leading to cellular immune inhibition following surgery. The primary objective of this study was to evaluate the effect of bilateral rectus sheath block on serum levels of TNF-α and IL-6 after radical prostatectomy. Methods: Fifty patients undergoing radical prostatectomy, under general anesthesia were randomly allocated into two groups. Group RSB: A bilateral single shot of 20 ml plain bupivacaine 0.25% or 20 ml normal saline (Group C) in each side of rectus sheath. Postoperative pain was controlled by morphine as a rescue analgesia. Primary outcome was postoperative serum levels of TNF-α and IL-6. Secondary outcome measures: The total morphine consumption and evaluation of the visual analog pain score at 24 and 48 h postoperative. Results: Both TNF-α and IL-6 were significantly lower in the RSB group at 24 h postoperative, the mean value of TNF-α was 76.26 ± 4.07 pg/ml in RSB group and 93.15 ± 6.90 pg/ml in the control group (p < 0.001), while IL-6 was 89.65 ± 13.00 and 102.6 ± 24.70 pg/ml in both groups respectively (p = 0.01). In RSB group, the visual analog pain score and the total morphine consumption were significantly lower (p < 0.05) during the first 24 h postoperative while, the first time requested for rescue analgesia was significantly longer (p < 0.001). Conclusion: General anesthesia combined with bilateral rectus sheath block could decrease serum level of TNF-α and IL-6 after radical prostatectomy as well as decrease postoperative pain intensity with less opioid administration.Clinical trials.gov ID: NCT03074097. Research hypothesisWe hypothesized that an effective postoperative analgesia by sonar guided bilateral rectus sheath block, may help to inhibit the release of postoperative TNF-α and IL-6.

PROSPECT guidelines update for evidence-based pain management after prostatectomy for cancer

“…Ibrahim 2018 [34] Open radical prostatectomy Placement of rectus sheath block (RSB) with 20 ml of bupivacaine (n = 25) on each side vs. 20 ml NaCl 0.9% on each side (n = 25).…”