The effect of rectus sheath block combined with intravenous analgesia which compared with versus epidural analgesia after cancer radical gastrectomy

Abstract

Objective To compare the analgesic effect of ultrasound-guided rectus sheath block (group R) combined with patient controlled intravenous analgesia to continuous epidural analgesia (group E) after radical gastrectomy. Methods one hundred and twenty adult patients (n=60). ASA grade Ⅰ or Ⅱ or Ⅲ and scheduled for radical gastrectomy were divided into two groups randomly (group R and group E). In group R, patients received ultrasound-guided rectus sheath block combined with patient-controlled intravenous analgesia after skin closure. In group E, an epidural catheter was prepositioned in the T8-T9 or T9-T11 before surgery. Patients received patient-controlled epidural analgesia(PCEA) after surgery. The primary outcome measures were the visual analogue scale scores at 2, 6, 12, 24, 36, 48 h after surgery. The percent of additional analgesic, the analgesic technique related side effects, the time to removal of the urinary catheter, the time to gastrointestinal function recovery, the time to walk and the length of hospital stay were recorded at 72 h postoperatively. Results There is no significant difference in visual analogue scale scores, supplemental analgesia, the recovery time of gastrointestinal function, the incidence of nausea and vomiting, and the duration of hospital stay(P>0.05). Compared with group E[3.5(3-4) d, 9(6-12) d, 25(43.10%), 16(27.58%)], group R had less time to the removal of the urinary catheter [2.0(1-4) d], less time to walk[5(2-11) d], less incidence of hypotension[8(13.56%)]and less times of suspending pump [4(6.78%)](P<0.05). Conclusions Two groups have similar analgesia effect and early rehabilitation. However, the complications of analgesia are less in patients with rectus sheath block combined with patient-controlled intravenous analgesia. Key words: Rectus sheath block; Epidural analgesia; Radical gastrectomy; Analgesia