Ultrasound-guided bilateral rectus sheath block analgesia and neutrophil-lymphocytes ratio in adult with midline laparotomy at Sanglah General Hospital: Case series

Abstract

This study aims to report our experience with ultrasound-guided bilateral rectus sheath block (RSB) in patients with midline laparotomy and evaluated neutrophil-lymphocytes ratio (NLR) value pre- and postoperatively. Midline laparotomy is associated with severe pain, high analgesia requirements, and inflammation after surgery. RSB is a simple and safe option for analgesia in midline laparotomy than other abdominal peripheral nerve blocks. In clinical studies, RSB has been shown to provide longer postoperative analgesia and less opioid consumption. General anesthesia and surgery is related with the activation of inflammatory responses. Peripheral nerve block is related to reduce inflammatory response, which NLR value is a simple marker to assess inflammatory response during perioperative period. Our case series included five patients undergoing laparotomy with bilateral RSB posterior approach. The range age of patients was 32–58 years old. After the induction of general anesthesia, RSB was performed by ultrasound guided. The Numeric Rating Scale (NRS), duration until first analgesia request postoperative and total opioid morphine consumption were recorded after surgery. NLR value was evaluated before and after surgery as the marker of inflammation. The results of NRS score were 0–2 in 24 h postoperative with range of total morphine consumption were 1–7 mg and duration of first analgesia request were 120–390 min. Our cases showed an increased NLR value 2–3 times postoperatively. No complication was found in these cases. Further study is needed to prove the effect of the RSB on the anti-inflammatory response.