Ultrasound guided bilateral rectus sheath block for post operative analgesia in patients undergoing umbilical surgeries under GA. A comparative study between bupivacaine, levobupivacaine and Ropivacaine

Abstract

: Ultrasound guided (US) rectus sheath block, blocks ventral rami of 7 to 12 thoracic nerves by injection of local anaesthetics (LA) into the space between the rectus muscle and posterior sheath. The aim of the study was to evaluate the analgesic efficacy of Bupivacaine, Levobupivacaine and Ropivacaine in ultrasound guided bilateral rectus sheath block in patients undergoing umbilical surgeries.: Patients received bilateral US-guided injection of total 30 mL of levobupivacaine (GpL) 0.25 % (or 0.375% of Ropivacaine (GpR) or 0.25%of Bupivacaine (GpB) respectively, behind the rectus muscle to detach it from its sheath. Analgesic efficacy of LA was evaluated using duration of analgesia, pain score at extubation and 1-16 hrs postoperatively and mean VAS (visual analogue scale) score to assess the quality of analgesia.: There were statistically significant differences in VAS scores between the groups L, R and B at all postoperative time points - 1hr, 2 hr, and 3hr till 16hrs. (P < 0.00001). The mean duration of analgesia in three groups was 9.30±0.92 hrs in Gp L, 13.02±1.17 hrs in Gp R and 6.2± 0.83hrs in Gp B respectively. This difference was statistically significant (p =< 0.0001). Single shot of different local Anaesthetics in Ultrasound guided bilateral rectus sheath block provides postoperative analgesia up till 16hrs in patients with BMI 25-40kg/m2 undergoing umbilical surgeries with excellent VAS scores with Ropivacaine.