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

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ABSTRACT Background: Rectus sheath block (RSB) had been proven to reduce the pain associated with ventral abdominal surgical incisions and laparoscopic surgery. We hypothesized that the addition of hyaluronidase could increase the effectiveness of the (RSB) technique by improving the local anesthetic (LA) spread. Objective of the study: effectiveness of adding the hyaluronidase as an adjuvant to bupivacaine in ultrasound-guided rectus sheath block (RSB) in those patients planning for laparoscopic cholecystectomy (LC). Patients and methods: Eighty patients, their ages range from 20-60 years old, ASA physical statuses I to III, and planning for elective (LC): were assigned in this study and allocated randomly into two equivalent groups. Group (R) had given rectus sheath block with 19 ml of bupivacaine 0.25%+1ml of hyaluronate 1500 IU, and control group (B) received rectus sheath block 19 ml of bupivacaine 0.25%+1ml of normal saline on each side after standardized induction sequence. Results: mean intraoperative fentanyl consumption exhibit a significant decline in Group H (167.75±20.6) compared to Group B (186.25±20.57) p < 0.001. Numerical Rating Score (NRS) was significantly less in the H group than in the B group at 0 hour, 2 hours, 4 hours, 6hours, postoperatively with A significant p-value. There was a significant decrease in the total dose of analgesia in 24hrs (P<0.001) in Group H (55.75±14.66) compared to Group B (82.50±36.57). Conclusion: Preoperative RSB by adding hyaluronidase to bupivacaine reduced the need for analgesia during the intraoperative time and 24 hours postoperatively in patients planning for LC, versus the preoperative RSB without hyaluronidase.